MEDICARE: BIGWAY FAMILY 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

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	:	1902410699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGWAY FAMILY DENTAL PLLC

Provider Business Mailing Address
First Line	:	11930 W US HIGHWAY 90 STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9613
Country	:	US
Telephone Number	:	210-858-5570
Fax Number	:	210-858-9494

Provider Business Practice Location Address
First Line	:	11930 W US HIGHWAY 90 STE 106
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78245-9613
Country	:	US
Telephone Number	:	210-858-5570
Fax Number	:	210-858-9494

Authorized Official
Title or Position	:	DENTIST
Name	:	AYODELE OLUROPO IFARAJIMI
Credential	:
Telephone Number	:	210-858-5570

Provider Enumeration Date	:	09/01/2020
Last Update Date	:	11/13/2025

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