MEDICARE: KEVIN JAMES DONLY DDS

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	15235	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	15235	OTHER	TX	TEXAS DENTAL LICENSE
3	84D665	OTHER		BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528094067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN JAMES DONLY DDS

Provider Business Mailing Address
First Line	:	P.O. BOX 40397
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3900
Country	:	US
Telephone Number	:	210-567-3274
Fax Number	:	210-567-2844

Provider Business Practice Location Address
First Line	:	7703 FLOYD CURL DR.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3900
Country	:	US
Telephone Number	:	210-567-3274
Fax Number	:	210-567-2844

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/18/2011

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Directions to “ KEVIN JAMES DONLY DDS” Practice Location

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