Healthcare Provider Details

I. General information

NPI: 1285890244
Provider Name (Legal Business Name): ERIC DYLAN KUHL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15321 SAN PEDRO AVE SUITE 104
SAN ANTONIO TX
78232-3700
US

IV. Provider business mailing address

15321 SAN PEDRO AVE SUITE 104
SAN ANTONIO TX
78232-3700
US

V. Phone/Fax

Practice location:
  • Phone: 210-496-1711
  • Fax: 210-496-0477
Mailing address:
  • Phone: 210-496-1711
  • Fax: 210-496-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20330
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: