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Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Active
Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Active
Parent organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Other names
Enhance Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Authorized official
GREGORY KOSTELAC (CREDENTIALING SPECIALIST)
(719) 372-5605
Entity
Organization
Contact information
Practice address
17230 AUTRY POND RD STE 115, SAN ANTONIO, TX 78247-2097
(210) 396-7667
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
12/21/2021
Last updated
12/21/2021
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