Provider Demographics
NPI:1417482324
Name:CONVERSE DENTISTRY
Entity Type:Organization
Organization Name:CONVERSE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PUNZALAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-568-9703
Mailing Address - Street 1:6643 BINZ ENGLEMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78109
Mailing Address - Country:US
Mailing Address - Phone:210-568-9703
Mailing Address - Fax:
Practice Address - Street 1:6643 BINZ ENGLEMAN ROAD
Practice Address - Street 2:6643 BINZ ENGLEMAN ROAD
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78109
Practice Address - Country:US
Practice Address - Phone:210-568-7898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty