Provider Demographics
NPI:1740360338
Name:DACY, JUSTIN ANTHONY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:ANTHONY
Last Name:DACY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:#1
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2036
Mailing Address - Country:US
Mailing Address - Phone:830-816-5102
Mailing Address - Fax:830-331-9535
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:#1
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2036
Practice Address - Country:US
Practice Address - Phone:830-816-5102
Practice Address - Fax:830-331-9535
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX213661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics