Provider Demographics
NPI:1437582236
Name:LEON SPRINGS DENTAL CENTER, PA
Entity Type:Organization
Organization Name:LEON SPRINGS DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:BOWMAN
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-698-1010
Mailing Address - Street 1:25235 W INTERSTATE 10
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9550
Mailing Address - Country:US
Mailing Address - Phone:210-698-1010
Mailing Address - Fax:210-698-1078
Practice Address - Street 1:25235 W INTERSTATE 10
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9550
Practice Address - Country:US
Practice Address - Phone:210-698-1010
Practice Address - Fax:210-698-1078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty