Individual
DR. KEN VANDEWALLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6535 CAGNON RD, SAN ANTONIO, TX 78252-2211
(210) 675-6620
Mailing address
6535 CAGNON RD, SAN ANTONIO, TX 78252-2211
(210) 675-6620
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12081
TX
Other
Enumeration date
08/04/2014
Last updated
08/04/2014
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