NPI | 1497935233 |
---|---|
Doing Business As | CENTROMED SOUTH PARK DENTAL |
Entity Type | Organization |
Authorized Contact | CHUCK WALZEL CFO 210-334-3724 |
Organization Subpart ? | No |
Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX HBOCS007758-04-00) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX HBOCS00758-04-00) |
1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX HBOCS00758-04-00) | |
Enumeration Date | 2007-11-09 |
Last Update Date | 2012-06-01 |