Provider Demographics
NPI:1871619593
Name:ETCHISON, PAMELA F (DDS)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:F
Last Name:ETCHISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 E HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-2430
Mailing Address - Country:US
Mailing Address - Phone:210-821-5316
Mailing Address - Fax:210-829-4686
Practice Address - Street 1:235 E HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2430
Practice Address - Country:US
Practice Address - Phone:210-821-5316
Practice Address - Fax:210-829-4686
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice