SP ADMINISTRATION
NPI: 1720526163
· SAN ANTONIO, TX 78249
· Dentist
· NPI assigned 02/06/2017
$0.00
Total Medicaid Paid
Provider Details
| Authorized Official | IZADDOUST, SHIVA (OWNER) |
| Parent Organization | SOUTHPARK FAMILY DENTAL CARE |
| NPI Enumeration Date | 02/06/2017 |
Related Entities
Other providers sharing the same authorized official: IZADDOUST, SHIVA
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2023 |
380 |
$0.00 |
| 2024 |
38 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0220 |
Intraoral - periapical first radiographic image |
111 |
98 |
$0.00 |
| D1120 |
Prophylaxis - child |
14 |
12 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
98 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
44 |
39 |
$0.00 |
| D0603 |
|
57 |
55 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
81 |
73 |
$0.00 |