Organization
VILLA DENTAL, PLLC
Active
Other names
Villa Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMANUEL J STAES D.D.S. (OWNER)
(504) 810-2760
Entity
Organization
Contact information
Practice address
1546 BABCOCK RD, STE 105, SAN ANTONIO, TX 78229-4724
(504) 810-2760
Mailing address
6215 VIA LA CANTERA APT 331, SAN ANTONIO, TX 78256-2537
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
28289
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336495738
—
TX
Enumeration date
07/11/2014
Last updated
02/04/2015
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