Provider Demographics
NPI:1174834253
Name:SARKIS FAMILY DENTAL, P.A.
Entity Type:Organization
Organization Name:SARKIS FAMILY DENTAL, P.A.
Other - Org Name:LEGACY SMILE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTOINE
Authorized Official - Middle Name:W
Authorized Official - Last Name:SARKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-577-8363
Mailing Address - Street 1:1711 ESCADA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4531
Mailing Address - Country:US
Mailing Address - Phone:210-577-8363
Mailing Address - Fax:
Practice Address - Street 1:3293 WURZBACH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4002
Practice Address - Country:US
Practice Address - Phone:210-699-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty