Provider Demographics
NPI:1255350435
Name:WESTSIDE PEDIATRIC DENTAL
Entity type:Organization
Organization Name:WESTSIDE PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:H
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MA
Authorized Official - Phone:210-673-3792
Mailing Address - Street 1:7322 MILITARY DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-2924
Mailing Address - Country:US
Mailing Address - Phone:210-673-3792
Mailing Address - Fax:210-673-8837
Practice Address - Street 1:7322 MILITARY DRIVE WEST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-2924
Practice Address - Country:US
Practice Address - Phone:210-673-3792
Practice Address - Fax:210-673-8837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty