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Organization
IVY LANE DENTISTRY
Active
Organization
IVY LANE DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW LOUIS WESTERBERG DDS (OWNER)
(210) 824-9566
Entity
Organization
Contact information
Practice address
1073 IVY LN, SAN ANTONIO, TX 78209-6061
(210) 824-9566
(210) 824-9975
Mailing address
1073 IVY LN, SAN ANTONIO, TX 78209-6061
(210) 824-9566
(210) 824-9975
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
19612
TX
Other
Enumeration date
11/01/2006
Last updated
04/07/2010
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