Provider Demographics
NPI:1396006714
Name:6 TO 9 DENTAL TEXAS,PLLC
Entity type:Organization
Organization Name:6 TO 9 DENTAL TEXAS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:POTTER HUMPHREY
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-333-6911
Mailing Address - Street 1:2603 SE MILITARY DRIVE
Mailing Address - Street 2:103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223
Mailing Address - Country:US
Mailing Address - Phone:210-333-6911
Mailing Address - Fax:
Practice Address - Street 1:2603 SE MILITARY DRIVE
Practice Address - Street 2:103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-333-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty