Provider Demographics
NPI:1104040666
Name:MALDONADO-BUITRAGO, ANA I (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:I
Last Name:MALDONADO-BUITRAGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 HUEBNER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1646
Mailing Address - Country:US
Mailing Address - Phone:210-614-3898
Mailing Address - Fax:210-614-3950
Practice Address - Street 1:10007 HUEBNER RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1646
Practice Address - Country:US
Practice Address - Phone:210-614-3898
Practice Address - Fax:210-614-3950
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14961223G0001X
TX229771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice