Provider Demographics
NPI:1164469938
Name:TEST, DON N III (DDS)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:N
Last Name:TEST
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6609 BLANCO RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6152
Mailing Address - Country:US
Mailing Address - Phone:210-349-3161
Mailing Address - Fax:210-349-3825
Practice Address - Street 1:6609 BLANCO RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6152
Practice Address - Country:US
Practice Address - Phone:210-349-3161
Practice Address - Fax:210-349-3825
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX101741223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0303OtherMEDICARE PTAN