NPIMap

Organization Active NPI

Mission Plaza Dental PLLC

Doing business as Smile Structure

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1104110501
Registry record updated Jun 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22951 Issued in TX
Legal business name
MISSION PLAZA DENTAL PLLC
Doing business as
Smile Structure
Practice address
3454 Roosevelt Ave.
San Antonio, TX 78214
Phone
(210) 546-1337
Fax
(210) 546-1348
NPI assigned
Jun 2, 2011
Last updated
Jun 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2011

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

Authorized official

Name
Dr. Andrew Thomas Scraver, DDSNPI 1629124797
Title
Owner
Phone
(210) 546-1337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 22951 TX Primary

Addresses

Primary practice location

3454 Roosevelt Ave.
San Antonio, TX 78214

Mailing address

3454 Roosevelt Ave.
San Antonio, TX 78214
Phone (210) 546-1337

Other names 1

  • Smile Structure Doing business as

National Provider Directory

National Provider Directory

Locations

3454 Roosevelt Ave
San Antonio, TX 78214
Phone (210) 546-1337

Practitioners & affiliated clinicians

Practitioners 3

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": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306972800000",
    "number": "1104110501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3454 ROOSEVELT AVE.",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78214",
            "telephone_number": "210-546-1337",
            "fax_number": "210-546-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3454 ROOSEVELT AVE.",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78214",
            "telephone_number": "210-546-1337",
            "fax_number": "210-546-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION PLAZA DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2011-06-02",
        "status": "A",
        "authorized_official_last_name": "SCRAVER",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-546-1337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22951",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smile Structure",
            "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 Jun 2, 2011; 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.