Provider Demographics
NPI:1992832786
Name:SKROBANEK, GARY P (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:SKROBANEK
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 1:3151 SE MILITARY DR STE 115
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-3986
Mailing Address - Country:US
Mailing Address - Phone:210-633-3477
Mailing Address - Fax:210-633-3480
Practice Address - Street 1:3151 SE MILITARY DR STE 115
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-3986
Practice Address - Country:US
Practice Address - Phone:210-633-3477
Practice Address - Fax:210-633-3480
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009341101Medicaid