Provider Demographics
NPI:1164860185
Name:ALAMO FAMILY & COSMETIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:ALAMO FAMILY & COSMETIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-639-0737
Mailing Address - Street 1:8131 W IH 10
Mailing Address - Street 2:SUITE 217
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3864
Mailing Address - Country:US
Mailing Address - Phone:210-348-8600
Mailing Address - Fax:210-348-8606
Practice Address - Street 1:8131 W IH 10
Practice Address - Street 2:SUITE 217
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3864
Practice Address - Country:US
Practice Address - Phone:210-348-8600
Practice Address - Fax:210-348-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23344122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty