Provider Demographics
NPI:1427225812
Name:ANDREW DE LA GARZA, JR., DDS, PA
Entity Type:Organization
Organization Name:ANDREW DE LA GARZA, JR., DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA GARZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-227-1991
Mailing Address - Street 1:315 N SAN SABA
Mailing Address - Street 2:SUITE 925
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3154
Mailing Address - Country:US
Mailing Address - Phone:210-227-1991
Mailing Address - Fax:
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:SUITE 925
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-227-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119441223G0001X
TX59431223G0001X
TX153481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11944OtherDENTAL LICENSE
TX15348OtherDENTAL LICENSE
TX1209736-02Medicaid
TXG60035-1OtherTEXAS CHIP DELTA DENTAL SERVICES
TX1332751-02Medicaid
TX5943OtherDENTAL LICENSE