Organization
ALAMO MAXILLOFACIAL SURGICAL ASSOCIATES, PA
Active
Organization
ALAMO MAXILLOFACIAL SURGICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY ANN SHY MHSM (PRACTICE ADMINISTRATOR)
(210) 614-3915
Entity
Organization
Contact information
Practice address
4499 MEDICAL DR, SUITE #190, SAN ANTONIO, TX 78229-3735
(210) 614-3915
(210) 614-3918
Mailing address
4499 MEDICAL DR, SUITE #190, SAN ANTONIO, TX 78229-3735
(210) 614-3915
(210) 614-3918
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014AW
MEDICARE
TX
05
—
079997501
—
TX
Enumeration date
01/10/2007
Last updated
04/25/2016
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