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Organization

COMMERCE ST FAMILY DENTAL

Active
Other names
Commerce St Family Dental Center PC
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ALFRED GWINN BRADFORD JR. DDS (CEO PRESIDENT CHAIRMAN OF BOARD)
(210) 225-4867
Entity
Organization

Contact information

Practice address
2522 W COMMERCE ST, SAN ANTONIO, TX 78207
(210) 225-4867
(210) 225-5643
Mailing address
2522 W COMMERCE ST, SAN ANTONIO, TX 78207
(210) 225-4867
(210) 225-5643

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
08923
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
87DO73
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/27/2006
Last updated
10/25/2007
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