Organization
NORTHEAST CHILDREN'S DENTISTRY, INC
Active
Parent organization
NORTHEAST CHILDREN'S DENTISTRY, INC
Other names
Northeast Children's Dentistry- Northern Oaks
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHEAST CHILDREN'S DENTISTRY, INC
Authorized official
TRACEY HAY (PRACTICE COORDINATOR)
(210) 654-6882
Entity
Organization
Contact information
Practice address
4358 THOUSAND OAKS DR, SAN ANTONIO, TX 78217-2102
(210) 656-4300
(210) 656-4302
Mailing address
4358 THOUSAND OAKS DR, SAN ANTONIO, TX 78217-2102
(210) 656-4300
(210) 656-4302
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00K78
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/16/2019
Last updated
11/27/2023
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