Organization
CELEBRACES BANDERA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID BURTON FERGUSON DDS (MANAGING MEMBER)
(210) 683-6353
Entity
Organization
Contact information
Practice address
6810 BANDERA RD, SUITE #2, SAN ANTONIO, TX 78238-1358
(210) 683-6353
Mailing address
6810 BANDERA RD, SUITE #2, SAN ANTONIO, TX 78238-1358
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
24904
—
Other
Enumeration date
01/15/2013
Last updated
01/15/2013
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