Organization
WISDOM TEETH RX PLLC
Active
Other names
210 Wisdom Teeth
Organization subpart
No
Provider details
NPI number
Authorized official
RAHUL MALYA DDS (MANAGING MEMBER)
(512) 985-7516
Entity
Organization
Contact information
Practice address
7254 BLANCO RD STE 107, SAN ANTONIO, TX 78216-4930
(210) 817-4480
Mailing address
4832 TRAIL CREST CIR, AUSTIN, TX 78735-6355
(512) 985-7516
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720368632
NPI TYPE 1
—
Enumeration date
09/01/2021
Last updated
09/01/2021
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