SOUTH PARK FAMILY DENTAL CARE PA NPI 1467586768

NPI Information

NPI: 1467586768
Provider Name: SOUTH PARK FAMILY DENTAL CARE PA
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
2310 SW MILITARY DR
STE 406
SAN ANTONIO, TX
ZIP 78224
Phone: (210) 927-1400
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SOUTH PARK FAMILY DENTAL CARE PA is a dental clinic center in San Antonio, TX. SOUTH PARK FAMILY DENTAL CARE PA NPI is 1467586768. The provider is registered as an organization entity type.

The provider's business location address is:

2310 SW MILITARY DR
STE 406
SAN ANTONIO, TX
ZIP 78224-407
Phone: (210) 927-1400
Fax: (210) 927-6330

The provider's authorized official is Shiva Izaddoust .
The authorized official title is President and has the following contact phone number (210) 927-1400.

The enumeration date for this NPI number is 3/16/2007 and was last updated on 5/24/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0099152-01	MEDICAID	TEXAS
2	G60126-3	OTHER	TEXAS	TEXAS CHIP
3	0064GJ	OTHER	TEXAS	BLUE CROSS BLUE SHIELD
4	1300537	OTHER	TEXAS	UNITED CONCORDIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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