Organization
AQUA INGRAM PLLC
Active
Other names
Aqua Dental Ingram
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO RIVERA (MANAGING MEMBER)
(972) 677-7845
Entity
Organization
Contact information
Practice address
6064 INGRAM RD, SAN ANTONIO, TX 78238-4402
(972) 677-7845
Mailing address
6064 INGRAM RD, SAN ANTONIO, TX 78238-4402
(972) 677-7845
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
Other
Enumeration date
10/06/2011
Last updated
10/06/2011
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