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General NPI Number Information
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NPI Number | 1093695660
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Entity Type | Organization
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Legal Business Name | CRANIOMANDIBULAR ASSOCIATES OF SAN ANTONIO PLLC
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 5 COUGHRAN RD STE 302
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City | BOERNE
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State | TX
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Zip | 78006-8103
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Country | US
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Telephone | 830-446-5510
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Fax |
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Provider Business Mailing Address
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Address Line | 114 UPPER BALCONES RD
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City | BOERNE
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State | TX
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Zip | 78006-8545
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Country | US
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Telephone | 830-446-5510
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TARA LEE CULLY
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Credential |
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Telephone | 830-446-5510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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