Organization
KUSOM PEDIATRIC DENTAL SOUTH PLLC
Active
Other names
Great Kids Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OSHMI DUTTA MD (CEO)
(210) 888-0700
Entity
Organization
Contact information
Practice address
1134 CULEBRA RD STE 109, SAN ANTONIO, TX 78201-6080
(210) 888-0700
(210) 625-7398
Mailing address
18707 HARDY OAK BLVD STE 305, SAN ANTONIO, TX 78258-4895
(210) 888-0700
(210) 625-7398
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
12/31/2019
Last updated
10/13/2020
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