Provider Demographics
NPI:1992736573
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL SCHOOL VICE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-567-3268
Mailing Address - Street 1:7703 FLOYD CURL DR.
Mailing Address - Street 2:RM 4.194R
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-567-3274
Mailing Address - Fax:210-567-2844
Practice Address - Street 1:7703 FLOYD CURL DR.
Practice Address - Street 2:RM 4.194R
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-567-3274
Practice Address - Fax:210-567-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
819382OtherUNITED CONCORDIA
TXG60211-02OtherCHIP
D85NOtherBLUE CROSS BLUE SHIELD
TX00N36NMedicare PIN
TX00D85NMedicare PIN