Dr. Randolph A Ibarra
Dentist - General Practice
8744 Grissom Rd
San Antonio
, Texas 78251-4819
Dr. Randolph A Ibarra
Dentist - General Practice
8744 Grissom Rd
San Antonio
, Texas 78251-4819
(210) 623-6112
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About
Features
Specialties
- General Practice
Languages spoken
- English
Location
First Address
- Dr. Randolph A Ibarra
- 8355 Crestway Dr 1126
- Converse, TX
- Zip : 78109-3596
- Phone : (210) 623-6112
Second Address
- Dr. Randolph A Ibarra
- 8744 Grissom Rd
- San Antonio, TX
- Zip : 78251-4819
- Fax : (210) 523-0067
- Phone : (210) 523-0000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223G0001X | General Practice | 14645 | TX |
| Y | 213EG0000X | General Practice | 14645 | TX |
National Provider Identifier
| NPI | 1003878034 |
|---|---|
| Provider Name | Dr. Randolph A Ibarra |
| First Address | Converse, TX 78109-3596 |
| Second Address | San Antonio, TX 78251-4819 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 05/04/2006 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.