Provider Demographics
NPI:1619186111
Name:BEATRIZ CANTU PETTY DDS PC
Entity Type:Organization
Organization Name:BEATRIZ CANTU PETTY DDS PC
Other - Org Name:DENTAL DOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:CANTU
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-532-9998
Mailing Address - Street 1:2358 E SOUTHCROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-2263
Mailing Address - Country:US
Mailing Address - Phone:210-532-9998
Mailing Address - Fax:
Practice Address - Street 1:2358 E SOUTHCROSS BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-2263
Practice Address - Country:US
Practice Address - Phone:210-532-9998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty