Provider Demographics
NPI:1750403887
Name:UTHSCSA DENTAL SCHOOL
Entity type:Organization
Organization Name:UTHSCSA DENTAL SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL SCHOOL VICE DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-567-3268
Mailing Address - Street 1:PO BOX 40397
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1397
Mailing Address - Country:US
Mailing Address - Phone:210-567-3274
Mailing Address - Fax:210-567-2844
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-3274
Practice Address - Fax:210-567-2844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N89TMedicare PIN