=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942415658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCHUYLER COSS JOYNER D.D.S., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 S GLENDORA AVE
-----------------------------------------------------
City | WEST COVINA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91790-3035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-918-8513
-----------------------------------------------------
Fax | 626-918-1642
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3037 CAPRI LN
-----------------------------------------------------
City | COSTA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92626-3501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-557-7077
-----------------------------------------------------
Fax | 714-557-7076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 15065
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------