Organization
BLUEBONNET ORAL SURGERY AND IMPLANTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREG RANDOLPH DDS (DENTIST)
(210) 344-9898
Entity
Organization
Contact information
Practice address
7300 BLANCO RD, SUITE 100, SAN ANTONIO, TX 78216-4936
(210) 344-9898
(210) 344-9118
Mailing address
7300 BLANCO RD, SUITE 100, SAN ANTONIO, TX 78216-4936
(210) 344-9898
(210) 344-9118
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12316
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12316
DENTAL LICENSE NUMBER
TX
01
—
14522
DENTAL LICENSE NUMBER
TX
Enumeration date
07/08/2013
Last updated
07/08/2013
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