Provider Demographics
NPI:1316202468
Name:WILLHITE, LOURDES ALEJANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:ALEJANDRA
Last Name:WILLHITE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14934 TURRET RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2713
Mailing Address - Country:US
Mailing Address - Phone:210-723-4211
Mailing Address - Fax:
Practice Address - Street 1:834 NW LOOP 410
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5602
Practice Address - Country:US
Practice Address - Phone:210-340-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice