NPIMap

Organization Active NPI

San Pedro Smiles P.a.

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1255628582
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22242 Issued in TX
Legal business name
SAN PEDRO SMILES P.A.
Practice address
5101 San Pedro Ave
Suite 102
San Antonio, TX 78212-1461
Phone
(210) 737-6900
Fax
(210) 737-6904
NPI assigned
Jul 7, 2011
Last updated
Jul 7, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Authorized official

Name
Dr. Justin J Gonzalez, DDS
Title
Owner -Dentist
Phone
(210) 737-6900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 22242 TX Primary

Addresses

Primary practice location

5101 San Pedro Ave
Suite 102
San Antonio, TX 78212-1461

Mailing address

5101 San Pedro Ave
Suite 102
San Antonio, TX 78212-1461
Phone (210) 737-6900

National Provider Directory

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

Other organizations with this tax ID 1

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

Locations

5101 San Pedro Ave
Ste 102
San Antonio, TX 78212
Phone (210) 737-6900

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1255628582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 SAN PEDRO AVE",
            "address_2": "SUITE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782121461",
            "telephone_number": "210-737-6900",
            "fax_number": "210-737-6904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 SAN PEDRO AVE",
            "address_2": "SUITE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782121461",
            "telephone_number": "210-737-6900",
            "fax_number": "210-737-6904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO SMILES P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER -DENTIST",
        "authorized_official_telephone_number": "210-737-6900",
        "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": "22242",
            "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 7, 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.