Provider Demographics
NPI:1295344679
Name:BULVERDE DENTAL SPECIALIST PLLC
Entity type:Organization
Organization Name:BULVERDE DENTAL SPECIALIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YUNHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-867-7489
Mailing Address - Street 1:22103 BULVERDE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-1855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22103 BULVERDE RD STE 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-1855
Practice Address - Country:US
Practice Address - Phone:210-907-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty