Provider Demographics
NPI:1518233733
Name:WILDERNSS OAK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WILDERNSS OAK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESTRELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-298-0800
Mailing Address - Street 1:20711 WILDERNESS OAK
Mailing Address - Street 2:SUITE #104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2640
Mailing Address - Country:US
Mailing Address - Phone:210-298-0800
Mailing Address - Fax:210-298-0801
Practice Address - Street 1:20711 WILDERNESS OAK
Practice Address - Street 2:SUITE #104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2640
Practice Address - Country:US
Practice Address - Phone:210-298-0800
Practice Address - Fax:210-298-0801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL E. ESTRELLA DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23980261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental