Organization
BRADFORD LEGACY DENTAL
Active
Other names
Next Generation Dental Spa and Cosmetics
Organization subpart
No
Provider details
NPI number
Authorized official
GWENDOLYN CALDERON D.D.S. (SOLE MEMBER)
(210) 655-4867
Entity
Organization
Contact information
Practice address
4158 SWANS LNDG, SAN ANTONIO, TX 78217-4239
(210) 655-4867
Mailing address
4158 SWANS LNDG, SAN ANTONIO, TX 78217-4239
(210) 655-4867
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1396831681
NPI
TX
01
—
1831602796
NPI
TX
Enumeration date
11/08/2021
Last updated
11/08/2021
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