Provider Demographics
NPI:1811077407
Name:NORTHWOODS DENTAL SPA
Entity type:Organization
Organization Name:NORTHWOODS DENTAL SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTISTS
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:KIANSKY
Authorized Official - Last Name:BLAESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-495-7800
Mailing Address - Street 1:18160 HWY 281 N
Mailing Address - Street 2:STE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-495-7800
Mailing Address - Fax:210-495-7805
Practice Address - Street 1:18160 HWY 281 NORTH
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232
Practice Address - Country:US
Practice Address - Phone:210-495-7800
Practice Address - Fax:210-495-7805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty