MEDICARE: DR. WILLIAM J CRUSE DDS

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		TX

General Provider Information

NPI Number	:	1760526024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM J CRUSE DDS

Provider Business Mailing Address
First Line	:	1662 ENCINO RIO
Second Line	:	SUITE 107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1825
Country	:	US
Telephone Number	:	210-481-7800
Fax Number	:	210-481-6708

Provider Business Practice Location Address
First Line	:	1662 ENCINO RIO
Second Line	:	SUITE 107
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-1825
Country	:	US
Telephone Number	:	210-481-7800
Fax Number	:	210-481-6708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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