MEDICARE: POTRANCO CHILDREN'S DENTAL ASSOCIATION

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1952066458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POTRANCO CHILDREN'S DENTAL ASSOCIATION

Provider Business Mailing Address
First Line	:	12991 POTRANCO RD STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7105
Country	:	US
Telephone Number	:	210-529-7995
Fax Number	:

Provider Business Practice Location Address
First Line	:	12991 POTRANCO RD STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-7105
Country	:	US
Telephone Number	:	210-634-4343
Fax Number	:	210-519-2956

Authorized Official
Title or Position	:	OWNER
Name	:	AARON SALINAS
Credential	:	DDS
Telephone Number	:	956-612-8062

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	12/22/2025

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