Provider Demographics
NPI:1023483062
Name:NEW HEIGHTS DENTAL AND BRACES PA
Entity type:Organization
Organization Name:NEW HEIGHTS DENTAL AND BRACES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-828-5300
Mailing Address - Street 1:7700 BROADWAY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3232
Mailing Address - Country:US
Mailing Address - Phone:210-828-5300
Mailing Address - Fax:210-828-3205
Practice Address - Street 1:7700 BROADWAY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-3232
Practice Address - Country:US
Practice Address - Phone:210-828-5300
Practice Address - Fax:210-828-3205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009274401Medicaid