Provider Demographics
NPI:1679465090
Name:DE SEQUERA, ADAM GABRIEL
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GABRIEL
Last Name:DE SEQUERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1790 OAKLAND BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7200
Mailing Address - Country:US
Mailing Address - Phone:210-294-3185
Mailing Address - Fax:
Practice Address - Street 1:9594 POTRANCO RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9619
Practice Address - Country:US
Practice Address - Phone:210-523-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-18
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice