Provider Demographics
NPI:1063832558
Name:WESTOVER HILLS FAMILY DENTAL CARE, LP
Entity Type:Organization
Organization Name:WESTOVER HILLS FAMILY DENTAL CARE, LP
Other - Org Name:SP ADMINISTRATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:INS COORD
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-927-1400
Mailing Address - Street 1:11212 STATE HIGHWAY 151
Mailing Address - Street 2:STE # 290
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4498
Mailing Address - Country:US
Mailing Address - Phone:210-257-0953
Mailing Address - Fax:
Practice Address - Street 1:11212 STATE HIGHWAY 151
Practice Address - Street 2:STE # 290
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:210-257-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty