Individual
DIANE TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4158 SWANS LNDG, SAN ANTONIO, TX 78217-4239
(210) 590-4867
Mailing address
1218 SW MILITARY DR, SAN ANTONIO, TX 78221-1535
(210) 590-4867
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
16878
TX
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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