Provider Demographics
NPI:1346257276
Name:LITTLE TEETH OF TEXAS DENTISTRY FOR CHILDREN PA
Entity Type:Organization
Organization Name:LITTLE TEETH OF TEXAS DENTISTRY FOR CHILDREN PA
Other - Org Name:LITTLE TEETH OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PEDICATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BILLICK-GERLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-497-8787
Mailing Address - Street 1:21714 HARDY OAK BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4838
Mailing Address - Country:US
Mailing Address - Phone:210-497-8787
Mailing Address - Fax:
Practice Address - Street 1:21714 HARDY OAK BLVD
Practice Address - Street 2:STE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-497-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty