Organization
CAM JANSE D.D.S. P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMPBELL RIDDICK JANSE D.D.S. (OWNER)
(210) 523-2400
Entity
Organization
Contact information
Practice address
9820 BRAUN RD, SUITE #102, SAN ANTONIO, TX 78254
(210) 523-2400
Mailing address
9820 BRAUN RD, SUITE #102, SAN ANTONIO, TX 78254
(210) 523-2400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13898
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1208456-04
—
TX
01
—
1D3898
BLUE CROSS BLUE SHIELD
TX
01
—
551692
UNITED CONCORDIA
TX
Enumeration date
08/03/2006
Last updated
04/15/2009
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