# DENTAL REPUBLIC PLAZA PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dental Republic West Ave
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033858006
- **Authorized official:** MR. SON TRAN DDS (PRESIDENT)
- **Authorized official phone:** (972) 747-1400

## Contact information

- **Practice address:** 11535 WEST AVE, SAN ANTONIO, TX 78213-1343
- **Practice address phone:** (210) 780-6000
- **Mailing address:** 3211 W NORTHWEST HWY \# 100, DALLAS, TX 75220-5944
- **Mailing address phone:** (972) 747-1400
- **Mailing address fax:** (214) 242-4455

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/30/2022
- **Last updated:** 05/30/2022