Provider Demographics
NPI:1346644549
Name:LEON SPRINGS FAMILY DENTAL
Entity Type:Organization
Organization Name:LEON SPRINGS FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARROQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-698-0610
Mailing Address - Street 1:24165 W IH 10
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:210-698-0610
Mailing Address - Fax:
Practice Address - Street 1:24165 W IH 10 STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1160
Practice Address - Country:US
Practice Address - Phone:210-698-0610
Practice Address - Fax:210-698-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty