Provider Demographics
NPI:1598099541
Name:SOUTH TEXAS SMILES, PLLC
Entity Type:Organization
Organization Name:SOUTH TEXAS SMILES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-614-3898
Mailing Address - Street 1:10007 HUEBNER RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1646
Mailing Address - Country:US
Mailing Address - Phone:210-614-3898
Mailing Address - Fax:210-614-3950
Practice Address - Street 1:10007 HUEBNER RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1646
Practice Address - Country:US
Practice Address - Phone:210-614-3898
Practice Address - Fax:210-614-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-23
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22977122300000X
TX8261122300000X
TX4540124Q00000X
TX12877124Q00000X
TX13272124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty