Organization
INGRAM MALL DENTAL CENTER, P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BERTHA ELIZABETH RODRIGUEZ (REGIONAL MANAGER)
(210) 354-4867
Entity
Organization
Contact information
Practice address
6301 NW LOOP 410, L1A, SAN ANTONIO, TX 78238-3824
(210) 354-4867
(210) 681-6985
Mailing address
6301 NW LOOP 410, L1A, SAN ANTONIO, TX 78238-3824
(210) 354-4867
(210) 681-6985
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
15889
TX
Other
Enumeration date
01/19/2010
Last updated
01/19/2010
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