Provider Demographics
NPI:1093832776
Name:SAN ANTONIO ORAL SURGERY, P.A.
Entity type:Organization
Organization Name:SAN ANTONIO ORAL SURGERY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-656-3301
Mailing Address - Street 1:3338 OAKWELL COURT
Mailing Address - Street 2:#204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218
Mailing Address - Country:US
Mailing Address - Phone:210-656-3301
Mailing Address - Fax:210-656-3304
Practice Address - Street 1:3338 OAKWELL COURT
Practice Address - Street 2:#204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218
Practice Address - Country:US
Practice Address - Phone:210-656-3301
Practice Address - Fax:210-656-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12736Medicare UPIN
TXT16554Medicare UPIN
TX00P814Medicare ID - Type UnspecifiedDR. COLEMAN
TXD13704Medicare ID - Type UnspecifiedDR. WERT