Organization Name: | SAN ANTONIO DENTAL SLEEP SOLUTIONS, LLC |
NPI Number: | 1003156035 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAFAEL L MERCADO (OWNER) |
Mailing Address: | 1354 Basse Rd Suite #3 San Antonio |
State: | TX US |
Postal Code: | 782121000 |
Phone Number: | 2107324570 |
Fax Number: | 2107324572 |
NPI Enumeration Date: | 02/28/2013 |
NPI Last Update Date: | 02/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332BC3200X |
License Number: | 17101 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | Customized Equipment |
Taxonomy Definition: |