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Organization
I SDG, PLLC
Active
Organization
I SDG, PLLC
Active
Other names
Southtown Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY PETER GUILLORY DDS (PRESIDENT/MANAGER)
(210) 227-0101
Entity
Organization
Contact information
Practice address
930 S ALAMO, SAN ANTONIO, TX 78205-3419
(210) 227-0101
(210) 212-6125
Mailing address
930 S ALAMO, SAN ANTONIO, TX 78205-3419
(210) 227-0101
(210) 212-6125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16271 TX
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0905986-02
—
TX
01
—
695689
UNITED CONCORDIA INS.
TX
01
—
B16271
DELTA DENTAL TEXAS CHIP
TX
Enumeration date
09/28/2006
Last updated
03/16/2010
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