Organization
THE DENTAL WISH FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVE GOLDWYN JEQUINTO DDS (MANAGER)
(310) 748-3742
Entity
Organization
Contact information
Practice address
12055 VANCE JACKSON RD STE 103, SAN ANTONIO, TX 78230-6058
(210) 568-9800
Mailing address
12055 VANCE JACKSON RD STE 103, SAN ANTONIO, TX 78230-6058
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
04/09/2021
Last updated
04/09/2021
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