Provider Demographics
NPI:1275336059
Name:CONVERSE FAMILY COSMETIC & IMPLANT DENTISTRY PLLC
Entity type:Organization
Organization Name:CONVERSE FAMILY COSMETIC & IMPLANT DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL/ HUMAN RESOURCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAFUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-898-8601
Mailing Address - Street 1:7228 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1205
Mailing Address - Country:US
Mailing Address - Phone:210-898-8601
Mailing Address - Fax:210-756-9161
Practice Address - Street 1:9160 FM 78 STE 1B
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2040
Practice Address - Country:US
Practice Address - Phone:210-607-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty