The Dental Wish Foundation

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

THE DENTAL WISH FOUNDATION

Practice address

12055 Vance Jackson Rd Ste 103
San Antonio, TX 78230-6058

Phone

(210) 568-9800

NPI assigned

Apr 9, 2021

Last updated

Apr 9, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dave Goldwyn Jequinto, DDSNPI 1437475019

Title

Manager

Phone

(310) 748-3742

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dave Goldwyn Jequinto, DDS

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1437475019
  NPD Authorized official
• Kelsey Marie Christensen

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1184351348
  NPD

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1861072274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12055 VANCE JACKSON RD STE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782306058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12055 VANCE JACKSON RD STE 103",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782306058",
            "telephone_number": "210-568-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE DENTAL WISH FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-09",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "JEQUINTO",
        "authorized_official_first_name": "DAVE GOLDWYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-748-3742",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Apr 9, 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.