Individual provider Active NPI

Leen Qutachi, DDS

  • Dentist
  • San Antonio, TX
National Provider Identifier
1083100564
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
37229 Issued in TX
Practice address
8610 Potranco Rd Ste 210
San Antonio, TX 78251-3034
Phone
(210) 585-4123
NPI assigned
Jul 8, 2018
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401416150 VA
Dentist 122300000X D010251 AZ
Dentist 122300000X 37229 TX Primary

Addresses

Primary practice location

8610 Potranco Rd Ste 210
San Antonio, TX 78251-3034

Mailing address

7907 Needle CRK
San Antonio, TX 78249-4369

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D010251AZMDDentist
37229TXMDDentist
0401416150VAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Andbraces, PLLC CurrentSince Jul 22, 2025 Accepting new patients
Emory Dentistry PLLC CurrentSince Jan 12, 2025 Accepting new patients
Potranco Dental and Braces PLLC CurrentSince Jul 31, 2022 Accepting new patients
Detailed Dental, PLLC General Practice PastSince Aug 1, 2021 Accepting new patients
Modern Dental Professionals Az, PC General Practice PastSince Jul 25, 2019 Accepting new patients

Locations

2113 W Loop 1604 S
Ste 207
San Antonio, TX 78245
Phone (210) 750-1087

8610 Potranco Rd
Ste 210
San Antonio, TX 78251
Phone (210) 568-9800

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1531008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1083100564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7907 NEEDLE CRK",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782494369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8610 POTRANCO RD STE 210",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782513034",
            "telephone_number": "210-585-4123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUTACHI",
        "first_name": "LEEN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-08",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401416150",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D010251",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "37229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 25, 2022; 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.