1487018271 NPI number — ADVANCED SMILE CARE FOR KIDS, PLLC

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 1487018271 NPI number — ADVANCED SMILE CARE FOR KIDS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SMILE CARE FOR KIDS, 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:
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:
1487018271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3829 LOCKHILL SELMA RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230-1761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-366-3606
Provider Business Mailing Address Fax Number:
210-332-9715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3829 LOCKHILL SELMA RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-366-3606
Provider Business Practice Location Address Fax Number:
210-332-9715
Provider Enumeration Date:
04/08/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SELIG
Authorized Official First Name:
JOS
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
210-366-3606

Provider Taxonomy Codes

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

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





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