=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073631339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAYS GENERAL DENTISTRY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 02/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3404 KERBEY LANE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-323-5050
-----------------------------------------------------
Fax | 512-323-9093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3404 KERBEY LANE
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-323-5050
-----------------------------------------------------
Fax | 512-323-9093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO DENTIST
-----------------------------------------------------
Name | DR. CELIA ANN TAYS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 512-323-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 17912
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------