Provider Demographics
NPI:1801326244
Name:GARZA, KELSEY BETH PENA (DDS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:BETH PENA
Last Name:GARZA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:BETH
Other - Last Name:PENA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4715 SHAVANO CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5889
Mailing Address - Country:US
Mailing Address - Phone:210-385-1347
Mailing Address - Fax:
Practice Address - Street 1:24200 IH 10 W STE 112
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1150
Practice Address - Country:US
Practice Address - Phone:210-687-1133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice