# SEVILLE PARK ENDODONTICS PLLC

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

## Provider details

- **NPI number:** 1740376540
- **Authorized official:** DR. TIMOTHY A INGRAM DMD MS (ENDODONTIST)
- **Authorized official phone:** (210) 617-8536

## Contact information

- **Practice address:** 8211 FREDERICKSBURG RD, SAN ANTONIO, TX 78229
- **Practice address phone:** (210) 617-5536
- **Practice address fax:** (210) 614-4266
- **Mailing address:** 8211 FREDERICKSBURG RD, SAN ANTONIO, TX 78229
- **Mailing address phone:** (210) 617-5536
- **Mailing address fax:** (210) 614-4266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 17400 | TX | Yes |
| 1223E0200X | Endodontics | 18608 | TX | — |

## Other

- **Enumeration date:** 10/05/2006
- **Last updated:** 08/22/2020