Provider Demographics
NPI:1881105419
Name:MY HOMETOWN DENTIST
Entity type:Organization
Organization Name:MY HOMETOWN DENTIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-640-8470
Mailing Address - Street 1:24200 W INTERSTATE 10 STE 112
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1150
Mailing Address - Country:US
Mailing Address - Phone:210-687-1133
Mailing Address - Fax:
Practice Address - Street 1:24200 W INTERSTATE 10 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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY HOMETOWN DENTIST AT LEON SPRINGS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-23
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23202261QD0000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1629284724OtherDENTIST