Provider Demographics
NPI:1265508956
Name:THE ORIGINAL BULVERDE DENTAL OFFICE, PA
Entity Type:Organization
Organization Name:THE ORIGINAL BULVERDE DENTAL OFFICE, PA
Other - Org Name:BULVERDE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-980-2869
Mailing Address - Street 1:2395 BULVERDE RD
Mailing Address - Street 2:#103
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163
Mailing Address - Country:US
Mailing Address - Phone:830-980-2869
Mailing Address - Fax:830-438-3363
Practice Address - Street 1:2395 BULVERDE RD
Practice Address - Street 2:#103
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163
Practice Address - Country:US
Practice Address - Phone:830-980-2869
Practice Address - Fax:830-438-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty