Provider Demographics
NPI:1578163390
Name:ATASCOSA DENTAL PLLC
Entity Type:Organization
Organization Name:ATASCOSA DENTAL PLLC
Other - Org Name:MY HOMETOWN DENTIST AT PLEASANTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-646-1833
Mailing Address - Street 1:24200 IH 10 W STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1150
Mailing Address - Country:US
Mailing Address - Phone:210-687-1133
Mailing Address - Fax:210-687-1132
Practice Address - Street 1:714 W GOODWIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4018
Practice Address - Country:US
Practice Address - Phone:830-569-4746
Practice Address - Fax:830-281-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty