Provider Demographics
NPI:1104394816
Name:CASSANDRA ELKINS DDS, PLLC
Entity Type:Organization
Organization Name:CASSANDRA ELKINS DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-268-0414
Mailing Address - Street 1:18330 GRAN MESA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2436
Mailing Address - Country:US
Mailing Address - Phone:210-289-8621
Mailing Address - Fax:210-694-5066
Practice Address - Street 1:9543 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1510
Practice Address - Country:US
Practice Address - Phone:210-268-0414
Practice Address - Fax:210-694-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368080302Medicaid