Provider Demographics
NPI:1982104139
Name:ALAMO KIDS DENTAL PLLC
Entity type:Organization
Organization Name:ALAMO KIDS DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GURR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-951-0046
Mailing Address - Street 1:6820 ALAMO PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6595
Mailing Address - Country:US
Mailing Address - Phone:210-951-0046
Mailing Address - Fax:210-688-4418
Practice Address - Street 1:6820 ALAMO PKWY STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6595
Practice Address - Country:US
Practice Address - Phone:210-951-0046
Practice Address - Fax:210-688-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558520262Medicaid