# CRESTA BELLA DENTAL AND BRACES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cresta Bella Dental and Braces
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093475212
- **Authorized official:** DR. DAVE GOLDWYN JEQUINTO DDS (OWNER/DENTIST)
- **Authorized official phone:** (210) 598-6002

## Contact information

- **Practice address:** 19787 IH 10 W STE 204, SAN ANTONIO, TX 78257-1695
- **Practice address phone:** (210) 598-6002
- **Mailing address:** 19787 IH 10 W STE 204, SAN ANTONIO, TX 78257-1695
- **Mailing address phone:** (210) 598-6002

## Taxonomy

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

## Other

- **Enumeration date:** 12/29/2021
- **Last updated:** 12/29/2021