Provider Demographics
NPI:1942599378
Name:TEXAN SMILE DENTISTRY
Entity Type:Organization
Organization Name:TEXAN SMILE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-354-4867
Mailing Address - Street 1:6301 NW LOOP 410 STE L1A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3829
Mailing Address - Country:US
Mailing Address - Phone:210-354-4867
Mailing Address - Fax:210-681-6985
Practice Address - Street 1:6301 NW LOOP 410 STE L1A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3829
Practice Address - Country:US
Practice Address - Phone:210-354-4867
Practice Address - Fax:210-681-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133327008Medicaid