Provider Demographics
NPI:1316763147
Name:DENTIST IN SAN ANTONIO LLC
Entity type:Organization
Organization Name:DENTIST IN SAN ANTONIO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:R
Authorized Official - Last Name:EAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-830-6881
Mailing Address - Street 1:6028 WORTH PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-5071
Mailing Address - Country:US
Mailing Address - Phone:803-830-6881
Mailing Address - Fax:
Practice Address - Street 1:6028 WORTH PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-5071
Practice Address - Country:US
Practice Address - Phone:803-830-6881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty