Provider Demographics
NPI:1235481870
Name:DOUBLE ARC DENTAL
Entity Type:Organization
Organization Name:DOUBLE ARC DENTAL
Other - Org Name:DUAL ARC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUKLERIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-375-5256
Mailing Address - Street 1:1248 FM 78
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154
Mailing Address - Country:US
Mailing Address - Phone:210-375-5256
Mailing Address - Fax:
Practice Address - Street 1:1248 FM 78
Practice Address - Street 2:SUITE 105
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154
Practice Address - Country:US
Practice Address - Phone:210-375-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental