XLNT Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30778 Issued in TX

Legal business name

XLNT DENTAL PLLC

Doing business as

Gravis & Riley Family Dental Care

Practice address

504 E Gravis St
San Diego, TX 78384-2708

Phone

(201) 970-9158

NPI assigned

Mar 7, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Daniela Marie P Punzalan, D.M.D.

Title

Owner/ General Dentist

Phone

(201) 970-9158

Specialties & licenses 1

Addresses

Other names 1

• Gravis & Riley Family Dental Care Doing business as

Locations

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

{
    "created_epoch": "1488844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488844800000",
    "number": "1346780566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 CANAVERAL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782174007",
            "telephone_number": "210-970-9158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 E GRAVIS ST",
            "city": "SAN DIEGO",
            "state": "TX",
            "postal_code": "783842708",
            "telephone_number": "201-970-9158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XLNT DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-07",
        "last_updated": "2017-03-07",
        "status": "A",
        "authorized_official_last_name": "PUNZALAN",
        "authorized_official_first_name": "DANIELA MARIE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/ GENERAL DENTIST",
        "authorized_official_telephone_number": "201-970-9158",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "30778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gravis & Riley Family Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• San Diego Independent School District
• Anabel Trevino
• Georgia Trevino
• Uvalde County Hospital Authority
• Dorothy Vela, PTA
• Ramon Zavala, LPTA

• General Practice Dentistry in San Diego, TX
• Providers in San Diego, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2017; 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.