Provider Demographics
NPI:1396557682
Name:SOUTHSIDE FAMILY DENTAL CENTER PC
Entity type:Organization
Organization Name:SOUTHSIDE FAMILY DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:ZERCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-862-3506
Mailing Address - Street 1:125 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1650
Mailing Address - Country:US
Mailing Address - Phone:210-921-0314
Mailing Address - Fax:210-610-5887
Practice Address - Street 1:125 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1650
Practice Address - Country:US
Practice Address - Phone:210-921-0314
Practice Address - Fax:210-610-5887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHSIDE CHILDREN'S DENTAL CENTER, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty