MEDICARE: BEXAR COUNTY DENTAL

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	:	1992990139
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEXAR COUNTY DENTAL

Provider Business Mailing Address
First Line	:	529 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1636
Country	:	US
Telephone Number	:	210-435-6090
Fax Number	:	210-435-7722

Provider Business Practice Location Address
First Line	:	529 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1636
Country	:	US
Telephone Number	:	210-435-6090
Fax Number	:	210-435-7722

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ABBY SIMPTON
Credential	:
Telephone Number	:	512-507-8107

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	12/11/2007

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Directions to “BEXAR COUNTY DENTAL ” Practice Location

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