Provider Demographics
NPI:1932162427
Name:STAUNTON, TRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:
Last Name:STAUNTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5227
Mailing Address - Country:US
Mailing Address - Phone:210-435-3333
Mailing Address - Fax:210-435-3334
Practice Address - Street 1:823 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5227
Practice Address - Country:US
Practice Address - Phone:210-435-3333
Practice Address - Fax:210-435-3334
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD49871223G0001X
TX261511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453465OtherAHCCCS