MEDICARE: SIXTO SAN MIGUEL DDS

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	16538	TX

General Provider Information

NPI Number	:	1962416024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIXTO SAN MIGUEL DDS

Provider Business Mailing Address
First Line	:	3233 WURZBACH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238
Country	:	US
Telephone Number	:	210-680-6325
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 WURZBACH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238
Country	:	US
Telephone Number	:	210-680-6325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/17/2012

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