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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