San Pedro Dental Associates, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17072 Issued in TX

Legal business name

SAN PEDRO DENTAL ASSOCIATES, PC

Practice address

16414 San Pedro Ave
#200
San Antonio, TX 78232-2277

Phone

(210) 499-0009

Fax

(210) 499-0002

NPI assigned

May 29, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Edie Dutton

Title

Administrative Assistant

Phone

(830) 981-9193

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235606400000",
    "number": "1366643496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16414 SAN PEDRO AVE",
            "address_2": "#200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322277",
            "telephone_number": "210-499-0009",
            "fax_number": "210-499-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16414 SAN PEDRO AVE",
            "address_2": "#200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322277",
            "telephone_number": "210-499-0009",
            "fax_number": "210-499-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO DENTAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-29",
        "last_updated": "2009-02-26",
        "status": "A",
        "authorized_official_last_name": "DUTTON",
        "authorized_official_first_name": "EDIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "830-981-9193",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "17072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Josephine San Miguel
• Lydia San Miguel, LCDC
• Olvia San Miguel, LPC
• Samantha Price San Miguel, MSN, APRN, FNP-C
• San Pedro Avenue Kids Dental
• San Pedro Health Services, Inc.
• San Pedro North Pediatric Dental
• San Pedro Nursing and Rehab Center LLC
• San Pedro Smiles P. a. (Blanco Smiles Dental Center)
• San Pedro Smiles P.a.

• 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 Feb 26, 2009; 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.