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Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Active
Organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Active
Parent organization
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Other names
Premier Dental Center San Antonio II
Organization subpart
Yes
Provider details
NPI number
Legal business name
MY LOCAL TEXAS DENTAL PRACTICE, PLLC
Authorized official
MICHELLE JOHNSON (CREDENTIALING SPECIALIST)
(509) 315-8338
Entity
Organization
Contact information
Practice address
12521 NACOGDOCHES RD STE 103, SAN ANTONIO, TX 78217-2117
(210) 653-3452
Mailing address
12521 NACOGDOCHES RD STE 103, SAN ANTONIO, TX 78217-2117
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
06/09/2021
Last updated
06/09/2021
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