San Pedro North Pediatric Dental

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

10762 Issued in TX

Legal business name

SAN PEDRO NORTH PEDIATRIC DENTAL

Practice address

17119 San Pedro Ave
San Antonio, TX 78232-2232

Phone

(210) 494-4699

Fax

(210) 495-0558

NPI assigned

Nov 8, 2006

Organization subpart

No

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

Authorized official

Name

Cynthia Anne Banker, DDS,MA

Title

Owner

Phone

(210) 494-4699

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1346310372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17119 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322232",
            "telephone_number": "210-494-4699",
            "fax_number": "210-495-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17119 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322232",
            "telephone_number": "210-494-4699",
            "fax_number": "210-495-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO NORTH PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "BANKER",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-494-4699",
        "authorized_official_credential": "DDS,MA"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "10762",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009622401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Olvia San Miguel, LPC
• Samantha Price San Miguel, MSN, APRN, FNP-C
• San Pedro Avenue Kids Dental
• San Pedro Dental Associates, PC
• San Pedro Health Services, Inc.
• San Pedro Nursing and Rehab Center LLC
• San Pedro Smiles P. a.
• San Pedro Smiles P.a.
• San Pedro Springs Emergency Physicians PLLC
• San Post Acute Partners, PLLC

• Pediatric Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; 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.