Northwest Dental Management, PA
Dentist, General Practice in San Antonio, TX. Organization (NPI-2).
NPI number1841290137
StatusActive
Last updated in NPPESMar 26, 2010
Details
- NPI
- 1841290137
- Entity type
- Organization (NPI-2)
- Legal business name
- Northwest Dental Management, PA
- Organization subpart
- No
- Enumeration date
- Jul 28, 2005
- Last updated
- Mar 26, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 13920 | TX | Yes |
Other names
- Mary B. Mellard, DDS (Doing Business As)
Practice location
24200 W Ih 10Suite 112
San Antonio, TX 78257-1145
Phone 210-687-1133 · Fax 210-687-1132
Mailing address
24200 W Ih 10Suite 112
San Antonio, TX 78257-1145
Phone 210-687-1133 · Fax 210-687-1132
Authorized official
Mary B Mellard
President
2106871133
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