Organization
SONTORA MAX PA
Active
Organization
SONTORA MAX PA
Active
Other names
Sonterra Oral and Maxillofacial Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BRYAN ROACH JR. DDS (ORAL SURGEON)
(210) 494-2005
Entity
Organization
Contact information
Practice address
1202 EAST SONTERRA BLVD, SUITE 801, SAN ANTONIO, TN 78258
(210) 494-2005
(210) 494-1332
Mailing address
1202 EAST SONTERRA BLVD, SUITE 801, SAN ANTONIO, TN 78258
(210) 494-2005
(210) 494-1332
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
22140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134188576
NPI PROVIDER
—
01
—
1972562312
NPI PROVIDER
—
Enumeration date
06/22/2007
Last updated
08/22/2020
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