=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740584515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYRIL JOSEPH DMD PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2011
-----------------------------------------------------
Last Update Date | 01/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7271 WURZBACH RD 205
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7271 WURZBACH RD SUITE # 205
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-614-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | GENERAL DENTIST
-----------------------------------------------------
Name | CYRIL JOSEPH
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 210-614-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 24773
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------