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Organization
SP ADMINISTRATION
Active
Organization
SP ADMINISTRATION
Active
Other names
Westover Hills Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHIVA IZADDOUST D.D.S. (PRESIDENT)
(210) 927-1400
Entity
Organization
Contact information
Practice address
11212 STATE HIGHWAY 151, SUITE 106 MEDICAL PLAZA 1, SAN ANTONIO, TX 78251-4498
(210) 257-0953
(210) 257-5265
Mailing address
11212 STATE HIGHWAY 151, SUITE 106 MEDICAL PLAZA 1, SAN ANTONIO, TX 78251-4498
(210) 257-0953
(210) 257-5265
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
17028
TX
Other
Enumeration date
05/24/2016
Last updated
05/24/2016
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