MEDICARE: DR. SUZANNE MARIE OKULY 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	122300000X	Dentist	15652	TX

General Provider Information

NPI Number	:	1255448999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUZANNE MARIE OKULY D.D.S.

Provider Business Mailing Address
First Line	:	23 ANCIENT BND
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78248-1640
Country	:	US
Telephone Number	:	210-317-7058
Fax Number	:	210-949-8904

Provider Business Practice Location Address
First Line	:	8410 DATAPOINT DR
Second Line	:	SOUTH TEXAS VETERANS HEALTH CARE SYSTEM AUDIE L. MURPHY
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3220
Country	:	US
Telephone Number	:	210-949-8900
Fax Number	:	210-949-8904

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	01/25/2012

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