MEDICARE: JANA-MARIE DANIELLE KOYLASS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	UTSA 756X	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20142555	OTHER		UTSA 756X

General Provider Information

NPI Number	:	1043494420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANA-MARIE DANIELLE KOYLASS D.D.S.

Provider Business Mailing Address
First Line	:	5623 HAMILTON WOLFE
Second Line	:	1224
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3991
Country	:	US
Telephone Number	:	210-567-3318
Fax Number	:

Provider Business Practice Location Address
First Line	:	7703 FLOYD CURL DR
Second Line	:	DEPARTMENT OF PERIODONTICS
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3901
Country	:	US
Telephone Number	:	210-567-3589
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2007
Last Update Date	:	12/21/2007

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