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Organization
RACKHAM DENTAL LLC
Active
Organization
RACKHAM DENTAL LLC
Active
Other names
Kids N More Dentist
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSHUA LEE RACKHAM DMD (DENTIST)
(801) 920-8772
Entity
Organization
Contact information
Practice address
6658 SUMMER FEST DRIVE, SAN ANTONIO, TX 78244
(801) 920-8772
Mailing address
PO BOX 201315, SAN ANTONIO, TX 78220-8315
(801) 920-8772
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
27186
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214414901
—
TX
Enumeration date
09/16/2015
Last updated
09/16/2015
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