Provider Demographics
NPI:1689845604
Name:ALAMO CITY DENTAL
Entity Type:Organization
Organization Name:ALAMO CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-573-2113
Mailing Address - Street 1:9594 POTRANCO RD.
Mailing Address - Street 2:STE. 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-573-2113
Mailing Address - Fax:
Practice Address - Street 1:9594 POTRANCO RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-573-2113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty