Provider Demographics
NPI:1386205284
Name:SERNA, PETER (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SERNA
Suffix:
Gender:M
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:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:POTH
Mailing Address - State:TX
Mailing Address - Zip Code:78147-0002
Mailing Address - Country:US
Mailing Address - Phone:830-534-0881
Mailing Address - Fax:
Practice Address - Street 1:5820 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2109
Practice Address - Country:US
Practice Address - Phone:210-375-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty