MEDICARE: OAK HOLLOW DENTAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	27102	TX

General Provider Information

NPI Number	:	1740626464
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK HOLLOW DENTAL, PLLC

Provider Business Mailing Address
First Line	:	2250 THOUSAND OAKS DR
Second Line	:	SUITE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3989
Country	:	US
Telephone Number	:	210-314-6635
Fax Number	:	210-314-6703

Provider Business Practice Location Address
First Line	:	2250 THOUSAND OAKS DR
Second Line	:	SUITE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3989
Country	:	US
Telephone Number	:	210-314-6635
Fax Number	:	210-314-6703

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. ROBYN KATHLENE ADAMS
Credential	:	DMD
Telephone Number	:	210-314-6635

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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