1275857625 NPI number — ACCESS DENTAL OF COMMERCE, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275857625 NPI number — ACCESS DENTAL OF COMMERCE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS DENTAL OF COMMERCE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275857625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4622 WEST COMMERCE
Provider Second Line Business Mailing Address:
SUITE #105
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-365-9115
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4622 WEST COMMERCE
Provider Second Line Business Practice Location Address:
SUITE #105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-365-9115
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PHAN
Authorized Official First Name:
TIEN
Authorized Official Middle Name:
DINH
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
682-365-9115

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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