Provider Demographics
NPI:1598506289
Name:OLMOS PARK FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:OLMOS PARK FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHALERAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-585-1064
Mailing Address - Street 1:14314 FLINT PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4137
Mailing Address - Country:US
Mailing Address - Phone:813-585-1064
Mailing Address - Fax:
Practice Address - Street 1:351 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2412
Practice Address - Country:US
Practice Address - Phone:210-694-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental