Provider Demographics
NPI:1194422386
Name:MFD DENTAL, PA
Entity type:Organization
Organization Name:MFD DENTAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:MACNEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-828-1392
Mailing Address - Street 1:303 E HILDEBRAND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2476
Mailing Address - Country:US
Mailing Address - Phone:210-828-1392
Mailing Address - Fax:210-829-1828
Practice Address - Street 1:15303 HUEBNER RD STE 17
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-0982
Practice Address - Country:US
Practice Address - Phone:210-828-1392
Practice Address - Fax:210-829-1828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty