Provider Demographics
NPI:1972017069
Name:BOERNE TX FAMILTY DENTISTRY PLLC
Entity Type:Organization
Organization Name:BOERNE TX FAMILTY DENTISTRY PLLC
Other - Org Name:BOERNE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LUIGI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:DO,DDS
Authorized Official - Phone:830-660-1669
Mailing Address - Street 1:1361 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2863
Mailing Address - Country:US
Mailing Address - Phone:830-816-6111
Mailing Address - Fax:830-249-6111
Practice Address - Street 1:1361 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2863
Practice Address - Country:US
Practice Address - Phone:830-816-6111
Practice Address - Fax:830-249-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22462261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental