Provider Demographics
NPI:1700906518
Name:SAN ANTONIO DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:SAN ANTONIO DENTAL ASSOCIATES
Other - Org Name:ELIZABETH MARYLL FARRIMOND DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARYLL
Authorized Official - Last Name:FARRIMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-690-4500
Mailing Address - Street 1:6253 VANCE JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3347
Mailing Address - Country:US
Mailing Address - Phone:210-690-4500
Mailing Address - Fax:210-690-5835
Practice Address - Street 1:6253 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3347
Practice Address - Country:US
Practice Address - Phone:210-690-4500
Practice Address - Fax:210-690-5835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189981223G0001X
TX76861223G0001X
TX227721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty