Provider Demographics
NPI:1487018271
Name:ADVANCED SMILE CARE FOR KIDS, PLLC
Entity Type:Organization
Organization Name:ADVANCED SMILE CARE FOR KIDS, PLLC
Other - Org Name:SCUBA SMILES FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOS
Authorized Official - Middle Name:
Authorized Official - Last Name:SELIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-366-3606
Mailing Address - Street 1:3829 LOCKHILL SELMA RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1761
Mailing Address - Country:US
Mailing Address - Phone:210-366-3606
Mailing Address - Fax:210-332-9715
Practice Address - Street 1:3829 LOCKHILL SELMA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1761
Practice Address - Country:US
Practice Address - Phone:210-366-3606
Practice Address - Fax:210-332-9715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty