San Pedro Avenue Kids Dental

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

SAN PEDRO AVENUE KIDS DENTAL

Practice address

17119 San Pedro Ave
San Antonio, TX 78232-2232

Phone

(720) 603-4800

NPI assigned

May 31, 2018

Organization subpart

No

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

Authorized official

Name

Gina Abrotsky

Title

Credentialing Specialist

Phone

(720) 603-4788

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1760974273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17119 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17119 SAN PEDRO AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322232",
            "telephone_number": "720-603-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN PEDRO AVENUE KIDS DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-31",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "ABROTSKY",
        "authorized_official_first_name": "GINA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "720-603-4788"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Pediatric Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; 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.