Active NPI
Samer A Bsoul, DDS MS
- Dentist
- San Antonio, TX
National Provider Identifier
1609965276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 21747
- Practice address
- 8111 Mainland Dr
Suite 102
San Antonio, TX 78240-3748 - Phone
- (210) 523-2700
- Fax
- (210) 523-2701
- NPI assigned
- Oct 12, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 21747 | TX | Primary |
Addresses
Primary practice location
8111 Mainland Dr
Suite 102
San Antonio, TX 78240-3748
Mailing address
8111 Mainland Dr
Suite 102
San Antonio, TX 78240-3748
Phone (210) 523-2700
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180497302 | Medicaid | TX | |
| 180497304 | Medicaid | TX | |
| 180497303 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21747 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Star Dental Center, P.a. | Past | Accepting new patients | |
| Texas Star Dental Center PA | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- San Antonio, TX
- NPI 1366869273
-
- General Practice Dentistry
- San Antonio, TX
- NPI 1033370721
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1473379200000",
"number": "1609965276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8111 MAINLAND DR",
"address_2": "SUITE 102",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782403748",
"telephone_number": "210-523-2700",
"fax_number": "210-523-2701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8111 MAINLAND DR",
"address_2": "SUITE 102",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782403748",
"telephone_number": "210-523-2700",
"fax_number": "210-523-2701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BSOUL",
"first_name": "SAMER",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-12",
"last_updated": "2016-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "21747",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180497302",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180497304",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "180497303",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.