Provider Demographics
NPI:1164602991
Name:SAMMY SMILES
Entity Type:Organization
Organization Name:SAMMY SMILES
Other - Org Name:POTRANCO FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-509-8400
Mailing Address - Street 1:10730 POTRANCO RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-3330
Mailing Address - Country:US
Mailing Address - Phone:210-509-8400
Mailing Address - Fax:210-509-8404
Practice Address - Street 1:10730 POTRANCO RD STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3330
Practice Address - Country:US
Practice Address - Phone:210-509-8400
Practice Address - Fax:210-509-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty