MEDICARE: SAN ANTONIO ENDODONTIC ASSOCIATES PA

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	1223E0200X	Endodontics	9354	TX

General Provider Information

NPI Number	:	1811983794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN ANTONIO ENDODONTIC ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1100 NW LOOP 410
Second Line	:	SUITE 515
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2263
Country	:	US
Telephone Number	:	210-341-8281
Fax Number	:	210-341-8282

Provider Business Practice Location Address
First Line	:	1100 NW LOOP 410
Second Line	:	SUITE 515
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-2263
Country	:	US
Telephone Number	:	210-341-8281
Fax Number	:	210-341-8282

Authorized Official
Title or Position	:	V PRESIDENT
Name	:	DR. JOHN W MYERS
Credential	:	DDS
Telephone Number	:	210-341-8281

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	08/22/2020

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1760605414 — ROY R. GONZALEZ,DDS,MSD,PA
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1881850022 — DR. KURT WORTHINGTON MYERS DDS
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Practice Fax: 210-341-8282

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