Provider Demographics
NPI:1629372602
Name:SOPD PLLC
Entity Type:Organization
Organization Name:SOPD PLLC
Other - Org Name:STONE OAK PEDIATRIC DENTISTRY OR DOMINION PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREECE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-491-4141
Mailing Address - Street 1:20322 HUEBNER RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3462
Mailing Address - Country:US
Mailing Address - Phone:210-491-4141
Mailing Address - Fax:210-494-4025
Practice Address - Street 1:20322 HUEBNER RD
Practice Address - Street 2:SUITE #103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3462
Practice Address - Country:US
Practice Address - Phone:210-491-4141
Practice Address - Fax:210-494-4025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty