1720513229 NPI number — SAGAR DENTAL

Table of content: DR. HANNAH KATE WILSON PHD, RDN, LRD (NPI 1932823549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720513229 NPI number — SAGAR DENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAGAR DENTAL
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:
6
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:
1720513229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17503 LA CANTERA PKWY
Provider Second Line Business Mailing Address:
#104-606
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78257-8207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-627-6305
Provider Business Mailing Address Fax Number:
210-681-8887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17803 LA CANTERA TER
Provider Second Line Business Practice Location Address:
#8122
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78256-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-627-6305
Provider Business Practice Location Address Fax Number:
210-681-8887
Provider Enumeration Date:
04/22/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SAGAR
Authorized Official First Name:
AALIE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-627-6305

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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