Provider Demographics
NPI:1972622967
Name:NIEBLA, ARMANDO ALBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:ALBERT
Last Name:NIEBLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5518
Mailing Address - Country:US
Mailing Address - Phone:210-736-0298
Mailing Address - Fax:210-736-6847
Practice Address - Street 1:302 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5518
Practice Address - Country:US
Practice Address - Phone:210-736-0298
Practice Address - Fax:210-736-6847
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX090983001Medicaid
TX742535981OtherTAX IDENTIFICATION