Provider Demographics
NPI:1487174280
Name:COSMETIC DENTISTRY OF SAN ANTONIO
Entity type:Organization
Organization Name:COSMETIC DENTISTRY OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-493-9944
Mailing Address - Street 1:16535 HUEBNER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1676
Mailing Address - Country:US
Mailing Address - Phone:210-493-9944
Mailing Address - Fax:210-493-9946
Practice Address - Street 1:16535 HUEBNER RD STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1676
Practice Address - Country:US
Practice Address - Phone:210-493-9944
Practice Address - Fax:210-493-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty