MEDICARE: DR. JULIO DE LA FUENTE D.D.S.

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	122300000X	Dentist	27041	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27041	TX

General Provider Information

NPI Number	:	1962797084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO DE LA FUENTE D.D.S.

Provider Business Mailing Address
First Line	:	20627 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4765
Country	:	US
Telephone Number	:	210-979-8232
Fax Number	:

Provider Business Practice Location Address
First Line	:	20627 HUEBNER RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4765
Country	:	US
Telephone Number	:	210-979-8232
Fax Number	:

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

Provider Enumeration Date	:	06/16/2011
Last Update Date	:	07/02/2014

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Directions to “ DR. JULIO DE LA FUENTE D.D.S.” Practice Location

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