MEDICARE: WILLIAM J. TINNELL DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	14822	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083988067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J. TINNELL DDS INC.

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	FALFURRIAS
State	:	TX
Zip	:	78355-0339
Country	:	US
Telephone Number	:	361-325-4288
Fax Number	:	361-325-5746

Provider Business Practice Location Address
First Line	:	1402 S ST MARYS ST STE C
Second Line	:
City	:	FALFURRIAS
State	:	TX
Zip	:	78355-5037
Country	:	US
Telephone Number	:	361-325-4288
Fax Number	:	361-325-5746

Authorized Official
Title or Position	:	ONWER/DR
Name	:	DR. WILLIAM J. TINNELL
Credential	:	DDS
Telephone Number	:	361-325-4288

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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