Provider Demographics
NPI:1083796882
Name:BEXAR DENTAL CENTER
Entity Type:Organization
Organization Name:BEXAR DENTAL CENTER
Other - Org Name:THE SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING/COLLECTIONS SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:YASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-771-7327
Mailing Address - Street 1:803 CASTROVILLE RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-3153
Mailing Address - Country:US
Mailing Address - Phone:210-435-6090
Mailing Address - Fax:
Practice Address - Street 1:803 CASTROVILLE RD
Practice Address - Street 2:SUITE 412
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3153
Practice Address - Country:US
Practice Address - Phone:210-435-6090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG-60109-4OtherTEXAS CHIP PROVIDER ID