Organization
SAN PEDRO NORTH PEDIATRIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA ANNE BANKER DDS,MA (OWNER)
(210) 494-4699
Entity
Organization
Contact information
Practice address
17119 SAN PEDRO AVE, SAN ANTONIO, TX 78232-2232
(210) 494-4699
(210) 495-0558
Mailing address
17119 SAN PEDRO AVE, SAN ANTONIO, TX 78232-2232
(210) 494-4699
(210) 495-0558
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10762
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009622401
—
TX
Enumeration date
11/08/2006
Last updated
10/24/2014
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