South Park Family Dental Care PA
NPI #1467586768 in San Antonio, Texas
Provider Information
- NPI Number
- 1467586768
- Entity Type
- Organization
- Organization Name
- South Park Family Dental Care PA
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 16, 2007
- Last Updated
- May 24, 2011
Practice Location
- Address
- 2310 SW MILITARY DR
- Address 2
- STE 406
- City
- San Antonio
- State
- Texas
- ZIP Code
- 78224-1407
- Phone
- (210) 927-1400
Authorized Official
- Name
- DR. SHIVA IZADDOUST, D.D.S.
- Title
- PRESIDENT
- Phone
- (210) 927-1400
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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