| South Park Family Dental Care Pa | |
|
2310 Sw Military Dr Ste 406 San Antonio TX 78224-1407 | |
| (210) 927-1400 | |
| (210) 927-6330 |
| Full Name | South Park Family Dental Care Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2310 Sw Military Dr, San Antonio, Texas |
| Authorized Official Name and Position | Shiva Izaddoust (PRESIDENT) |
| Authorized Official Contact | 2109271400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Park Family Dental Care Pa 2310 Sw Military Dr Ste 406 San Antonio TX 78224-1407 Ph: (210) 927-1400 | South Park Family Dental Care Pa 2310 Sw Military Dr Ste 406 San Antonio TX 78224-1407 Ph: (210) 927-1400 |
| NPI Number | 1467586768 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 05/24/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467586768 | NPI | - | NPPES |
| G60126-3 | Other | TX | TEXAS CHIP |
| 0064GJ | Other | TX | BLUE CROSS BLUE SHIELD |
| 1300537 | Other | TX | UNITED CONCORDIA |
| 0099152-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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