# TEXAS DENTAL SPECIALIST PRACTICE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** TEXAS DENTAL SPECIALIST PRACTICE, PLLC
- **Other names:** Texas Dental Specialists
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1942960885
- **Legal business name:** TEXAS DENTAL SPECIALIST PRACTICE, PLLC
- **Authorized official:** GREGORY KOSTELAC (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (719) 372-5605

## Contact information

- **Practice address:** 21950 BULVERDE RD STE 103, SAN ANTONIO, TX 78259-2174
- **Practice address phone:** (210) 494-8850
- **Mailing address:** 6110 BARNES RD, COLORADO SPRINGS, CO 80922-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/20/2021
- **Last updated:** 07/26/2022