KUSOM PEDIATRIC DENTAL SOUTH PLLC (NPI# 1669011235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669011235 |
| Entity Type | Organization |
| Organization Name | KUSOM PEDIATRIC DENTAL SOUTH PLLC |
| Other Organization Name | GREAT KIDS DENTAL |
| Practice Address |
1134 Culebra Rd Ste 109 San Antonio TX 78201-6080 |
| Mailing Address |
18707 Hardy Oak Blvd Ste 305 San Antonio TX 78258-4895 |
| Practice Telephone | 2108880700 |
| Practice Fax Number | 2106257398 |
| Mailing Telephone | 2108880700 |
| Mailing Fax Number | 2106257398 |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2020-10-13 |
| Authorized Official Name | DR. OSHMI DUTTA (CEO) |
| Authorized Official Telephone | 2108880700 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Great Kids Dental | Doing Business As Name - Organization |
| Street Address |
1134 CULEBRA RD STE 109 |
| City | SAN ANTONIO |
| State | TX |
| Zip Code | 78201-6080 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336759828 | Qinlin Chen | Dentist | 1134 Culebra Rd Ste 109, San Antonio, TX 78201-6080 | 2020-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043864648 | Woodlawn Lake Dental Partners Pllc | Dentist | 1707 Williams, San Antonio, TX 78201 | 2019-07-31 |
| 1912559840 | Tara Devi Nath | Dentist | 1770 Williams, San Antonio, TX 78201 | 2019-07-11 |
| 1205329042 | Louis A Gonzalez | Registered Nurse | 2362 W Gramercy Pl, San Antonio, TX 78201 | 2018-06-06 |
| 1194212860 | Zarzamora Healthcare LLC | Pharmacy | 6800 W Ih 10 # 200a, San Antonio, TX 78201 | 2018-04-18 |
| 1891211926 | Jessica Ann Salazar | Specialist/Technologist | 511 Crestview Dr, San Antonio, TX 78201 | 2017-08-21 |
| 1093262172 | Access Dental of Fredericksburg Pa | Dentist | 4315 Fredericksburg Balcones Height, 100a, San Antonio, TX 78201 | 2016-09-06 |
| 1144664962 | Raymond Evan Skunda | Orthopaedic Surgery | 6800 W Ih 10 Ste 250, San Antonio, TX 78201 | 2013-04-23 |
| 1114289477 | Shaun D Perryman | Dentist | 4522 Fredericksbug Rd., Ste A28, San Antonio, TX 78201 | 2012-06-13 |
| 1871872093 | Jose Miguel Urencio Marcue | Surgery | 6800 W Ih 10 Ste 200, San Antonio, TX 78201 | 2011-08-04 |
| 1962719658 | Julio C Mata | Specialist/Technologist, Other | 426 Concord Pl, San Antonio, TX 78201 | 2010-09-02 |
| Find all providers in zip 78201 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295344679 | Bulverde Dental Specialist Pllc | Dentist | 22103 Bulverde Rd Ste 108, San Antonio, TX 78259-1855 | 2020-07-30 |
| 1407478027 | Rittiman Pediatric Dentistry, Pllc | Dentist | 5723 N Foster Rd, San Antonio, TX 78244-1204 | 2020-05-18 |
| 1114563590 | Zaida Liliana Nieves Lopez | Dentist | 226 Serna Park, San Antonio, TX 78218-2035 | 2019-11-21 |
| 1356997126 | Northeast Children's Dentistry, Inc | Dentist | 315 N San Saba Ste 202, San Antonio, TX 78207-3193 | 2019-08-16 |
| 1033765094 | Northeast Children's Dentistry, Inc | Dentist | 21727 Ih 10 W Ste 203, San Antonio, TX 78257-2107 | 2019-08-15 |
| 1598310344 | Celebraces Se Military Pllc | Dentist | 3611 Se Military Drive, Suite B101, San Antonio, TX 78223 | 2019-08-08 |
| 1972068401 | Aventura Dental | Dentist | 11915 Perrin Beitel Rd, San Antonio, TX 78217-2127 | 2019-02-08 |
| 1427513316 | San Antonio Pediatric Dentistry, Pllc | Dentist | 17026 Bulverde Rd Ste 102, San Antonio, TX 78247-4700 | 2019-02-05 |
| 1104394816 | Cassandra Elkins Dds, Pllc | Dentist | 9543 Huebner Rd, San Antonio, TX 78240-1510 | 2018-11-12 |
| 1558849893 | Purple Iris Dental Association | Dentist | 18010 Bulverde Rd Ste 112, San Antonio, TX 78259-3346 | 2018-07-30 |
| Find all providers in SAN ANTONIO | ||||
| City | SAN ANTONIO |
| Zip Code | 78201 |
Please comment or provide details below to improve the information on KUSOM PEDIATRIC DENTAL SOUTH PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.