Provider Demographics
NPI:1598216038
Name:WADHWA DENTAL PA
Entity Type:Organization
Organization Name:WADHWA DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARMANDEEP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:WADHWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-827-2873
Mailing Address - Street 1:2828 GOLIAD RD
Mailing Address - Street 2:120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3960
Mailing Address - Country:US
Mailing Address - Phone:210-468-1743
Mailing Address - Fax:
Practice Address - Street 1:2828 GOLIAD RD
Practice Address - Street 2:120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3960
Practice Address - Country:US
Practice Address - Phone:210-468-1743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WADHWA DENTAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24863261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental