Provider Demographics
NPI:1215327143
Name:NOVEL CARE DENTAL, PLLC
Entity type:Organization
Organization Name:NOVEL CARE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-400-6363
Mailing Address - Street 1:4727 MANITOU
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1112
Mailing Address - Country:US
Mailing Address - Phone:210-681-5272
Mailing Address - Fax:210-681-5273
Practice Address - Street 1:4727 MANITOU
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1112
Practice Address - Country:US
Practice Address - Phone:210-681-5272
Practice Address - Fax:210-681-5273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25637122300000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Yes122300000XDental ProvidersDentistGroup - Single Specialty