Provider Demographics
NPI:1811467541
Name:UT HEALTH SCIENCE CENTER
Entity type:Organization
Organization Name:UT HEALTH SCIENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM CHAIR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-450-3504
Mailing Address - Street 1:8210 FLOYD CURL DR # MC8118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3923
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8210 FLOYD CURL DR # MC8118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3923
Practice Address - Country:US
Practice Address - Phone:210-450-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty