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Organization
SP ADMINISTRATION
Active
Organization
SP ADMINISTRATION
Active
Parent organization
SOUTHPARK FAMILY DENTAL CARE
Other names
SPRINGTIME FAMILY DENTAL CARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHPARK FAMILY DENTAL CARE
Authorized official
DR. SHIVA IZADDOUST D.D.S. (OWNER)
(210) 927-1400
Entity
Organization
Contact information
Practice address
6510 BABCOCK RD, SUITE 106, SAN ANTONIO, TX 78249
(210) 558-7000
(210) 558-7001
Mailing address
6510 BABCOCK RD, SUITE # 106, SAN ANTONIO, TX 78249
(210) 558-7000
(210) 558-7001
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136343411
—
TX
Enumeration date
02/06/2017
Last updated
02/06/2017
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