Provider Demographics
NPI:1790934198
Name:REWARI, SMITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SMITA
Middle Name:
Last Name:REWARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:210-928-2814
Mailing Address - Fax:
Practice Address - Street 1:2901 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:A-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-8101
Practice Address - Country:US
Practice Address - Phone:512-328-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice