NPIMap

Organization Active NPI

San Pedro Smiles P. a.

Doing business as Blanco Smiles Dental Center

  • Dental Clinic/Center
  • San Antonio, TX
National Provider Identifier
1073954228
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
22242 Issued in TX
Legal business name
SAN PEDRO SMILES P. A.
Doing business as
Blanco Smiles Dental Center
Practice address
7254 Blanco Rd Ste 207
San Antonio, TX 78216-4930
Phone
(210) 341-7116
Fax
(210) 366-9479
NPI assigned
Jul 16, 2013
Last updated
Jul 16, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SAN PEDRO SMILES P. A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin Josiah Gonzalez, DDS
Title
President
Phone
(210) 341-7116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 22242 TX Primary

Addresses

Primary practice location

7254 Blanco Rd Ste 207
San Antonio, TX 78216-4930

Mailing address

7254 Blanco Rd Ste 207
San Antonio, TX 78216-4930
Phone (210) 341-7116

Other names 1

  • Blanco Smiles Dental Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
San Pedro Smiles P a2 organizations share this tax ID, including this one
Part of
San Pedro Smiles P a

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7254 Blanco Rd
Ste 207
San Antonio, TX 78216
Phone (210) 341-7116

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373932800000",
    "number": "1073954228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7254 BLANCO RD STE 207",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164930",
            "telephone_number": "210-341-7116",
            "fax_number": "210-366-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7254 BLANCO RD STE 207",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164930",
            "telephone_number": "210-341-7116",
            "fax_number": "210-366-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO SMILES P. A.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN PEDRO SMILES P. A.",
        "enumeration_date": "2013-07-16",
        "last_updated": "2013-07-16",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "JOSIAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-341-7116",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "22242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blanco Smiles Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.