Provider Demographics
NPI:1407154503
Name:ENCINO COMMONS, PLLC
Entity Type:Organization
Organization Name:ENCINO COMMONS, PLLC
Other - Org Name:7 TO 7 DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-495-2000
Mailing Address - Street 1:2339 E EVANS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2717
Mailing Address - Country:US
Mailing Address - Phone:210-495-2000
Mailing Address - Fax:210-495-2001
Practice Address - Street 1:2339 E EVANS RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2717
Practice Address - Country:US
Practice Address - Phone:210-495-2000
Practice Address - Fax:210-495-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX245371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty