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Organization
TEXAS DENTAL ORTHODONTICS PRACTICE, PLLC
Active
Organization
TEXAS DENTAL ORTHODONTICS PRACTICE, PLLC
Active
Other names
San Antonio Orthodontic Group
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY KOSTELAC (DATA ANALYST)
(719) 266-2717
Entity
Organization
Contact information
Practice address
1583 E COMMON ST STE 205, NEW BRAUNFELS, TX 78130-3174
(830) 625-2111
Mailing address
6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/07/2022
Last updated
07/07/2022
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