Provider Demographics
NPI:1558849893
Name:PURPLE IRIS DENTAL ASSOCIATION
Entity type:Organization
Organization Name:PURPLE IRIS DENTAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-634-4343
Mailing Address - Street 1:11831 CULEBRA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-4578
Mailing Address - Country:US
Mailing Address - Phone:210-634-4343
Mailing Address - Fax:210-519-2956
Practice Address - Street 1:18010 BULVERDE RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-3346
Practice Address - Country:US
Practice Address - Phone:210-634-4343
Practice Address - Fax:210-519-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty