Provider Demographics
NPI:1992262182
Name:MILLENNIUM DENTAL
Entity type:Organization
Organization Name:MILLENNIUM DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-438-5415
Mailing Address - Street 1:30070 HWY 281 NORTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30070 HWY 281 NORTH
Practice Address - Street 2:SUITE 200
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163
Practice Address - Country:US
Practice Address - Phone:830-438-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144002609Medicaid