Provider Demographics
NPI:1740515873
Name:SOUTH TEXAS PERIODONTEL ASSOCIATES
Entity type:Organization
Organization Name:SOUTH TEXAS PERIODONTEL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-654-7878
Mailing Address - Street 1:15321 SAN PEDRO
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3700
Mailing Address - Country:US
Mailing Address - Phone:210-654-7878
Mailing Address - Fax:210-402-0410
Practice Address - Street 1:15321 SAN PEDRO
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3700
Practice Address - Country:US
Practice Address - Phone:210-654-7878
Practice Address - Fax:210-402-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2955221223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty