Organization
BROADWAY PEDIATRIC DENTISTRY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOANNA AYALA (OWNER)
(121) 063-2456
Entity
Organization
Contact information
Practice address
3006 BROADWAY STE 103, SAN ANTONIO, TX 78209-1561
(210) 225-8888
Mailing address
PO BOX 356, LYTLE, TX 78052-0356
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
03/04/2022
Last updated
03/04/2022
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