Wisdom Teeth RX PLLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

WISDOM TEETH RX PLLC

Doing business as

210 Wisdom Teeth

Practice address

7254 Blanco Rd Ste 107
San Antonio, TX 78216-4930

Phone

(210) 817-4480

NPI assigned

Sep 1, 2021

Organization subpart

No

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

Authorized official

Name

Rahul Malya, DDSNPI 1720368632

Title

Managing Member

Phone

(512) 985-7516

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• 210 Wisdom Teeth 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.

• Rahul Malya

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1720368632
  NPD Authorized official

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1538837851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4832 TRAIL CREST CIR",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787356355",
            "telephone_number": "512-985-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7254 BLANCO RD STE 107",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782164930",
            "telephone_number": "210-817-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISDOM TEETH RX PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A",
        "authorized_official_last_name": "MALYA",
        "authorized_official_first_name": "RAHUL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "512-985-7516",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1720368632",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "210 Wisdom Teeth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tommy Lamar Winton Jr.
• Wioos, LLC
• Orion David Wirick, LPC
• Michael D Wirt II, M.D., PH.D.
• Michael A Wirth, MD
• Anthony Michael Wisdom, RPH
• Julie Harding Wisdom, PA-C
• Brenda K Wise-Yount
• David S. Wise, M.D.
• Jason Wise, PSY.D.

• Dental Clinic/Center in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dental Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.