# SAN MARCOS DENTAL AND BRACES PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336912864
- **Authorized official:** ROSA WOLFFORD (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (210) 568-9800

## Contact information

- **Practice address:** 102 WONDER WORLD DR STE 101, SAN MARCOS, TX 78666-6080
- **Practice address phone:** (210) 944-0504
- **Mailing address:** PO BOX 849, JASPER, TX 75951-0010

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 11/06/2023
- **Last updated:** 11/13/2023