Provider Demographics
NPI:1952380511
Name:SAN ANTONIO SURGICAL ARTS, P.A.
Entity Type:Organization
Organization Name:SAN ANTONIO SURGICAL ARTS, P.A.
Other - Org Name:CASILLAS, POOL AND THORNTON, D.D.S. P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:CASILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-341-7264
Mailing Address - Street 1:6501 BLANCO RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6627
Mailing Address - Country:US
Mailing Address - Phone:210-341-7264
Mailing Address - Fax:210-308-1077
Practice Address - Street 1:6501 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6627
Practice Address - Country:US
Practice Address - Phone:210-341-7264
Practice Address - Fax:210-341-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223S0112X
1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009624008Medicaid
TX023065801Medicaid
TX009624001Medicaid
00N96AOtherBCBS
TX009624002Medicaid
TX009624003Medicaid
TX009624005Medicaid
TX009624006Medicaid
TX009624007Medicaid
838355OtherUNITED CONCORDIA
CE7550OtherRAILROAD MEDICARE
TX009624002Medicaid