Provider Demographics
NPI:1780038679
Name:NAUTICAL DENTAL
Entity Type:Organization
Organization Name:NAUTICAL DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:
Authorized Official - Last Name:FALES
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:210-499-0009
Mailing Address - Street 1:16414 SAN PEDRO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2277
Mailing Address - Country:US
Mailing Address - Phone:210-499-0009
Mailing Address - Fax:210-499-0002
Practice Address - Street 1:16414 SAN PEDRO AVE
Practice Address - Street 2:STE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2277
Practice Address - Country:US
Practice Address - Phone:210-499-0009
Practice Address - Fax:210-499-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty