Adam Mucci, DDS
Individual provider Active NPI Dentist · Jbsa Lackland Afb, TX
NPI 1124728464 · NPPES record last updated Aug 8, 2024
Key facts
- NPI
- 1124728464
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 40797 (TX)
- Practice address
- 1100 Wilford Hall Loop
Jbsa Lackland Afb, TX 78236 - Phone
- (929) 335-4123
- NPI assigned
- Mar 6, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 40797 | TX | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 40797 | TX | Yes |
Addresses
Primary practice location
1100 Wilford Hall Loop
Jbsa Lackland Afb, TX 78236
Mailing address
1615 Truemper St
San Antonio, TX 78236-5511
Phone (210) 292-0123
Other providers in Jbsa Lackland Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.