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Organization
SAN MARCOS DENTAL AND BRACES PLLC
Active
Organization
SAN MARCOS DENTAL AND BRACES PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA WOLFFORD (CREDENTIALING SPECIALIST)
(210) 568-9800
Entity
Organization
Contact information
Practice address
102 WONDER WORLD DR STE 101, SAN MARCOS, TX 78666-6080
(210) 944-0504
Mailing address
PO BOX 849, JASPER, TX 75951-0010
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
11/06/2023
Last updated
11/13/2023
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