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Organization
KUSOM DENTAL BROADWAY PLLC
Active
Organization
KUSOM DENTAL BROADWAY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SELINDA GONZALEZ (OFFICE MANAGER)
(210) 888-0700
Entity
Organization
Contact information
Practice address
8852 BROADWAY # 201, SAN ANTONIO, TX 78217-6318
(210) 888-0700
Mailing address
18707 HARDY OAK BLVD STE 305, SAN ANTONIO, TX 78258-4895
(210) 888-0700
(210) 625-7398
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
10/27/2023
Last updated
05/20/2024
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