Provider Demographics
NPI:1972863314
Name:DENTAL DENTAL PLLC
Entity Type:Organization
Organization Name:DENTAL DENTAL PLLC
Other - Org Name:MR. DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:G
Authorized Official - Last Name:BADER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-366-0100
Mailing Address - Street 1:11535 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1343
Mailing Address - Country:US
Mailing Address - Phone:210-366-0100
Mailing Address - Fax:210-366-0103
Practice Address - Street 1:11535 WEST AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-1343
Practice Address - Country:US
Practice Address - Phone:210-366-0100
Practice Address - Fax:210-366-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty