Provider Demographics
NPI:1033310503
Name:HERITAGE DENTAL CENTER
Entity Type:Organization
Organization Name:HERITAGE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-673-9051
Mailing Address - Street 1:1420 S ELLISON DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1523
Mailing Address - Country:US
Mailing Address - Phone:210-673-9051
Mailing Address - Fax:210-673-9053
Practice Address - Street 1:1420 S ELLISON DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1523
Practice Address - Country:US
Practice Address - Phone:210-673-9051
Practice Address - Fax:210-673-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX141021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty