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Organization
RECONSTRUCTIVE DENTAL SPECIALISTS OF TEXAS
Active
Organization
RECONSTRUCTIVE DENTAL SPECIALISTS OF TEXAS
Active
Other names
Great Life Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAWZI HIJAZI DDS (CEO)
(210) 821-5316
Entity
Organization
Contact information
Practice address
235 E HILDEBRAND AVE STE 200, SAN ANTONIO, TX 78212-2430
(210) 821-5316
Mailing address
235 E HILDEBRAND AVE # 200, SAN ANTONIO, TX 78212-2430
(210) 821-5316
(210) 829-4686
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
—
NULL
1223P0700X
Prosthodontics
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
04/14/2020
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