Provider Demographics
NPI:1457825937
Name:SW MILITARY
Entity Type:Organization
Organization Name:SW MILITARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:JANSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-923-8066
Mailing Address - Street 1:1402 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1556
Mailing Address - Country:US
Mailing Address - Phone:210-923-8066
Mailing Address - Fax:210-923-8554
Practice Address - Street 1:1402 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1556
Practice Address - Country:US
Practice Address - Phone:210-923-8066
Practice Address - Fax:210-923-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental