SOUTH PARK FAMILY DENTAL CARE PA (NPI# 1467586768) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467586768 |
| Entity Type | Organization |
| Organization Name | SOUTH PARK FAMILY DENTAL CARE PA |
| Practice Address |
2310 Sw Military Dr Ste 406 San Antonio TX 78224-1407 |
| Practice Telephone | 2109271400 |
| Practice Fax Number | 2109276330 |
| Mailing Telephone | 2109271400 |
| Mailing Fax Number | 2109276330 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-05-24 |
| Authorized Official Name | DR. SHIVA IZADDOUST (PRESIDENT) |
| Authorized Official Telephone | 2109271400 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | UNITED CONCORDIA | 1300537 | 01 |
| TX | TEXAS CHIP | G60126-3 | 01 |
| TX | BLUE CROSS BLUE SHIELD | 0064GJ | 01 |
| TX | 0099152-01 | 05 |
| Street Address |
2310 SW MILITARY DR STE 406 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78224-1407 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801883616 | Jose San Martin IIi | Optometrist | 2310 Sw Military Dr, Suite 501, San Antonio, TX 78224-1407 | 2005-10-06 |
| 1831434604 | Sana Wellness and Health | Respite Care | 2310 Sw Military Dr, Suite 402, San Antonio, TX 78224-1407 | 2012-12-05 |
| 1669721320 | Suhail Daraiseh | Chiropractor | 2310 Sw Military Dr, Suite 402, San Antonio, TX 78224-1407 | 2012-09-09 |
| 1700182276 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 2310 Sw Military Dr, South Park Mall, San Antonio, TX 78224-1407 | 2011-02-01 |
| 1730496761 | Northland Hearing Centers Inc | Audiologist-Hearing Aid Fitter | 2310 Sw Military Dr, San Antonio, TX 78224-1407 | 2010-09-13 |
| 1558682153 | Ali Back & Body Inc | Chiropractor | 2310 Sw Military Dr, No. 404, San Antonio, TX 78224-1407 | 2010-06-17 |
| 1609060599 | Vesta Broumand-mizani | Dentist | 2310 Sw Military Dr, Suite #406, San Antonio, TX 78224-1407 | 2007-09-04 |
| 1376678755 | Linda Jean Braun | Optometrist | 2310 Sw Military Dr, 432, San Antonio, TX 78224-1407 | 2007-02-23 |
| 1649317421 | Shiva Izaddoust | Dentist | 2310 Sw Military Dr, Suite 406, San Antonio, TX 78224-1407 | 2007-01-31 |
| 1720144561 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 2310 Sw Military Dr, South Park Mall, San Antonio, TX 78224-1407 | 2006-12-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083215222 | Caleb Paul Cruz | Physical Therapy Assistant | 98 Briggs Ave, Ste 990, San Antonio, TX 78224 | 2020-11-04 |
| 1770124984 | Lillian Cerritos | Physical Therapist | 7719 I-35 S. #213, San Antonio, TX 78224 | 2019-09-30 |
| 1730606211 | Stephanie Hernandez | Physical Therapy Assistant | 2227 Sundrop Bay, San Antonio, TX 78224 | 2017-08-25 |
| 1770012155 | Pedro Daniel Godoy Sr. | Technician | 9422 Hindi St., San Antonio, TX 78224 | 2017-06-08 |
| 1417408642 | Lynda Marie Perez | Specialist/Technologist | 98 Briggs Ave #990, San Antonio, TX 78224 | 2016-10-24 |
| 1679933832 | Cvs Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 8731 Poteet Jourdanton Freeway, San Antonio, TX 78224 | 2016-03-02 |
| 1699157495 | Samantha Gonzalez | Obstetrics & Gynecology | 7430 Barlite Blvd Ste 105, San Antonio, TX 78224 | 2015-06-29 |
| 1043601206 | Abraham A Alecozay Md Pa Phd | Obstetrics & Gynecology | 7430 Barlite Suite 105, San Antonio, TX 78224 | 2015-02-10 |
| 1265846794 | Ashley Arellano | Speech-Language Pathologist | 98 Briggs Avenue, Suite 990, San Antonio, TX 78224 | 2014-06-12 |
| 1912310244 | Jose Angel Musquiz Jr. | Massage Therapist | 7423 Yarrow Blvd Apt 3107, San Antonio, TX 78224 | 2014-06-04 |
| Find all providers in zip 78224 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587431 | Mysa Dental Pllc | Clinic/Center | 13762 Potranco Rd, Suite 400, San Antonio, TX 78253 | 2020-10-30 |
| 1932706173 | Crossway Dental Care Pllc | Clinic/Center | 16616 San Pedro Ave, San Antonio, TX 78232-2223 | 2020-10-01 |
| 1902410699 | Bigway Family Dental Pllc | Clinic/Center | 11930 U.s . Hwy. 90, West, Suite 106, San Antonio, TX 78252 | 2020-09-01 |
| 1528676053 | Calm Spring Dental | Clinic/Center | 11034 W Military Drive, Suite 104, San Antonio, TX 78251 | 2020-07-21 |
| 1811516164 | Solorzano and Soto Dds P.l.l.c. | Clinic/Center | 14603 Huebner Rd Bldg 14, San Antonio, TX 78230-5483 | 2020-04-15 |
| 1821629080 | C3tsd Enterprises Pllc | Clinic/Center | 523 Med Ct # 106, San Antonio, TX 78258-3359 | 2020-01-27 |
| 1649814294 | Dental Oral Care, Pllc | Clinic/Center | 23535 W Interstate 10 Ste 2202, San Antonio, TX 78257-1673 | 2019-11-06 |
| 1093368342 | Dental Hut Pllc | Clinic/Center | 5514 Lone Star Pkwy Ste 111, San Antonio, TX 78253-6770 | 2019-07-16 |
| 1639633480 | Empire Dental | Clinic/Center | 1915 Rogers Road, San Antonio, TX 78251-7825 | 2019-01-25 |
| 1679068290 | Bcgg Pllc | Clinic/Center | 19787 W Ih 10 Ste 204, San Antonio, TX 78257-1695 | 2018-06-26 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78224 |
Please comment or provide details below to improve the information on SOUTH PARK FAMILY DENTAL CARE PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.