MEDICARE: JOHN L. COVERT, DDS, PA

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	14036	TX

General Provider Information

NPI Number	:	1790092930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN L. COVERT, DDS, PA

Provider Business Mailing Address
First Line	:	7701 TEZEL RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-3039
Country	:	US
Telephone Number	:	210-647-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	7701 TEZEL RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-3039
Country	:	US
Telephone Number	:	210-647-0477
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN LELAND COVERT
Credential	:	DDS
Telephone Number	:	210-647-0477

Provider Enumeration Date	:	09/09/2010
Last Update Date	:	09/09/2010

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