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Organization
WISDOM TEETH RX PLLC
Active
Organization
WISDOM TEETH RX PLLC
Active
Other names
210 Wisdom Teeth
Organization subpart
No
Provider details
NPI number
Authorized official
RAHUL MALYA DDS (MANAGING MEMBER)
(512) 985-7516
Entity
Organization
Contact information
Practice address
7254 BLANCO RD STE 107, SAN ANTONIO, TX 78216-4930
(210) 817-4480
Mailing address
4832 TRAIL CREST CIR, AUSTIN, TX 78735-6355
(512) 985-7516
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
09/01/2021
Last updated
09/01/2021
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