Healthcare Provider Details

I. General information

NPI: 1235344854
Provider Name (Legal Business Name): JOSEPH SIMON BOYLE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 LOUIS PASTEUR DR #205
SAN ANTONIO TX
78229-4514
US

IV. Provider business mailing address

7400 LOUIS PASTEUR DR #205
SAN ANTONIO TX
78229-4514
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8866
  • Fax: 210-614-0508
Mailing address:
  • Phone: 210-614-8866
  • Fax: 210-614-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: