MEDICARE: PAN AM DENTAL LP

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	261Q00000X	Clinic/Center	20176	TX
2	261Q00000X	Clinic/Center	20173	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750409686
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAN AM DENTAL LP

Provider Business Mailing Address
First Line	:	8261 FREDERICKSBURG RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3357
Country	:	US
Telephone Number	:	210-924-7277
Fax Number	:	210-922-5199

Provider Business Practice Location Address
First Line	:	600 DIVISION AVE
Second Line	:	SUITE A
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-1350
Country	:	US
Telephone Number	:	210-342-2000
Fax Number	:	210-342-2517

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. BARBARA MATA
Credential	:
Telephone Number	:	210-342-2000

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	04/25/2012

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Directions to “PAN AM DENTAL LP ” Practice Location

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