Provider Demographics
NPI:1558695569
Name:CARDENAS EITTER, GISELLE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:GISELLE
Middle Name:
Last Name:CARDENAS EITTER
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E SONTERRA BLVD STE 100
Mailing Address - Street 2:100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4071
Mailing Address - Country:US
Mailing Address - Phone:907-947-0240
Mailing Address - Fax:
Practice Address - Street 1:335 E SONTERRA BLVD STE 100
Practice Address - Street 2:100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4071
Practice Address - Country:US
Practice Address - Phone:907-947-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-23
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000108401223E0200X
TX277051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX27705OtherENDODONTIST