=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235306887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESLEY ZBORIL, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2008
-----------------------------------------------------
Last Update Date | 10/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 430 MEYER ST
-----------------------------------------------------
City | SEALY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77474-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-885-4856
-----------------------------------------------------
Fax | 979-885-6524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 430 MEYER ST
-----------------------------------------------------
City | SEALY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77474-2744
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-885-4856
-----------------------------------------------------
Fax | 979-885-6524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WESLEY B ZBORIL
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 979-885-4856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13430
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------