Provider Demographics
NPI:1942359286
Name:SHAVANO PARK FAMILY DENTISTRY, PA
Entity Type:Organization
Organization Name:SHAVANO PARK FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYEN
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-764-8600
Mailing Address - Street 1:4466 LOCKHILL SELMA RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2078
Mailing Address - Country:US
Mailing Address - Phone:210-764-8600
Mailing Address - Fax:210-764-0844
Practice Address - Street 1:4466 LOCKHILL SELMA RD
Practice Address - Street 2:STE. 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2078
Practice Address - Country:US
Practice Address - Phone:210-764-8600
Practice Address - Fax:210-764-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty