1104394816 NPI number — CASSANDRA ELKINS DDS, PLLC

Table of content: (NPI 1104394816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104394816 NPI number — CASSANDRA ELKINS DDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASSANDRA ELKINS DDS, PLLC
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:
1104394816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18330 GRAN MESA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78259-2436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-289-8621
Provider Business Mailing Address Fax Number:
210-694-5066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9543 HUEBNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-268-0414
Provider Business Practice Location Address Fax Number:
210-694-5066
Provider Enumeration Date:
11/12/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ELKINS
Authorized Official First Name:
CASSANDRA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
210-268-0414

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 368080302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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