I SDG, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

16271 TX Issued in TX

Legal business name

I SDG, PLLC

Doing business as

Southtown Dental Group

Practice address

930 S Alamo
San Antonio, TX 78205-3419

Phone

(210) 227-0101

Fax

(210) 212-6125

NPI assigned

Sep 28, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Gary Peter Guillory, DDS

Title

President/Manager

Phone

(210) 227-0101

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Southtown Dental Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacie Lynne Harris, RDH

  • Dental Hygienist
  • San Antonio, TX
  • NPI 1619485554
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1366533747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 S ALAMO",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782053419",
            "telephone_number": "210-227-0101",
            "fax_number": "210-212-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 S ALAMO",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782053419",
            "telephone_number": "210-227-0101",
            "fax_number": "210-212-6125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "I SDG, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "GUILLORY",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "PETER",
        "authorized_official_title_or_position": "PRESIDENT/MANAGER",
        "authorized_official_telephone_number": "210-227-0101",
        "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": "16271 TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA INS.",
            "identifier": "695689",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0905986-02",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL TEXAS CHIP",
            "identifier": "B16271",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southtown Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Grace Elizabeth Iacuone, M.ED., LPC

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, 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 16, 2010; 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.