Healthcare Provider Details

I. General information

NPI: 1528094067
Provider Name (Legal Business Name): KEVIN JAMES DONLY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR.
SAN ANTONIO TX
78229-3900
US

IV. Provider business mailing address

P.O. BOX 40397
SAN ANTONIO TX
78229-3900
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-3274
  • Fax: 210-567-2844
Mailing address:
  • Phone: 210-567-3274
  • Fax: 210-567-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: