Provider Demographics
NPI:1013106731
Name:ATIQUE ORTHODONTICS, P.A.
Entity type:Organization
Organization Name:ATIQUE ORTHODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ISABEL
Authorized Official - Last Name:ATIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-497-5500
Mailing Address - Street 1:340 TREELINE PARK
Mailing Address - Street 2:# 1229
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1888
Mailing Address - Country:US
Mailing Address - Phone:210-826-7422
Mailing Address - Fax:
Practice Address - Street 1:2770 E EVANS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2752
Practice Address - Country:US
Practice Address - Phone:210-497-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty