Organization
SOUTHSIDE CHILDRENSA DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DORIS ZERCHER (OFFICE MANAGER)
(210) 922-3483
Entity
Organization
Contact information
Practice address
125 SW MILITARY DR, SAN ANTONIO, TX 78221-1650
(210) 922-3483
Mailing address
125 SW MILITARY DR, SAN ANTONIO, TX 78221-1650
(210) 922-3483
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
14060
TX
1223P0221X
Pediatric Dentistry
23705
WI
1223P0221X
Pediatric Dentistry
25239
PA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
27696
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009833701
—
TX
05
—
126722102
—
TX
05
—
204974401
—
TX
05
—
209944201
—
TX
05
—
2882862
—
TX
Enumeration date
11/04/2013
Last updated
11/04/2013
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