Provider Demographics
NPI:1043653892
Name:CIBOLO DENTER CENTER PLLC
Entity Type:Organization
Organization Name:CIBOLO DENTER CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-658-7200
Mailing Address - Street 1:3893 CIBOLO VALLEY DR
Mailing Address - Street 2:104
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108
Mailing Address - Country:US
Mailing Address - Phone:210-658-7200
Mailing Address - Fax:210-658-7206
Practice Address - Street 1:3893 CIBOLO VALLEY DR
Practice Address - Street 2:104
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108
Practice Address - Country:US
Practice Address - Phone:210-658-7200
Practice Address - Fax:210-658-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty