Organization
RECONSTRUCTIVE DENTAL SPECIALISTS OF TEXAS
Active
Other names
Great Life Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FAWZI HIJAZI DDS (CEO)
(210) 821-5316
Entity
Organization
Contact information
Practice address
235 E HILDEBRAND AVE STE 200, SAN ANTONIO, TX 78212-2430
(210) 821-5316
Mailing address
235 E HILDEBRAND AVE # 200, SAN ANTONIO, TX 78212-2430
(210) 821-5316
(210) 829-4686
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
04/14/2020
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