Organization
BLUEBONNET ORAL SURGERY AND IMPLANTS PLLC
Active
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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