MEDICARE: STILLWATER DENTAL CARE LLC

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

General Provider Information

NPI Number	:	1881482339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STILLWATER DENTAL CARE LLC

Provider Business Mailing Address
First Line	:	5619 W LOOP 1604 N STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5795
Country	:	US
Telephone Number	:	803-830-6881
Fax Number	:

Provider Business Practice Location Address
First Line	:	5619 W LOOP 1604 N STE 112
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5795
Country	:	US
Telephone Number	:	803-830-6881
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. SUNIL R EAMANI
Credential	:
Telephone Number	:	803-830-6881

Provider Enumeration Date	:	04/25/2025
Last Update Date	:	04/25/2025

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Directions to “STILLWATER DENTAL CARE LLC ” Practice Location

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