# LA TOOTH DOC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1699638874
- **Authorized official:** TRACY WALTERS-BADILLO DMD (OWNER, DMD)
- **Authorized official phone:** (859) 492-7565

## Contact information

- **Practice address:** 12951 HUEBNER RD UNIT 780982, SAN ANTONIO, TX 78278-7837
- **Practice address phone:** (859) 492-7565
- **Mailing address:** 12951 HUEBNER RD UNIT 780982, SAN ANTONIO, TX 78278-7837
- **Mailing address phone:** (859) 492-7565

## Taxonomy

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

## Other

- **Enumeration date:** 12/04/2025
- **Last updated:** 12/04/2025