Provider Demographics
NPI:1710213699
Name:SAN MARTIN-PABLOS, LAURA ELENA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELENA
Last Name:SAN MARTIN-PABLOS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:SAN MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:PO BOX 780603
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78278-0603
Mailing Address - Country:US
Mailing Address - Phone:210-341-3123
Mailing Address - Fax:210-341-3122
Practice Address - Street 1:2803 MOSSROCK STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5131
Practice Address - Country:US
Practice Address - Phone:210-341-3123
Practice Address - Fax:210-341-3122
Is Sole Proprietor?:No
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics