Texas Dental Specialist Practice, Pllc
NPI #1659031599 in Universal City, Texas
Provider Information
- NPI Number
- 1659031599
- Entity Type
- Organization
- Organization Name
- Texas Dental Specialist Practice, Pllc
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- TEXAS DENTAL SPECIALIST PRACTICE, PLLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Dec 20, 2021
- Last Updated
- Jul 26, 2022
Practice Location
- Address
- 1621 PAT BOOKER RD
- City
- Universal City
- State
- Texas
- ZIP Code
- 78148-3432
- Phone
- (210) 654-9094
Authorized Official
- Name
- GREGORY KOSTELAC
- Title
- CREDENTIALING SPECIALIST
- Phone
- (719) 372-5605
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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