Craniomandibular Associates of San Antonio PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

CRANIOMANDIBULAR ASSOCIATES OF SAN ANTONIO PLLC

Practice address

5 Coughran Rd Ste 302
Boerne, TX 78006-8103

Phone

(830) 446-5510

NPI assigned

Sep 4, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tara Lee CullyNPI 1538447685

Title

Ceo

Phone

(830) 446-5510

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tara Lee Cully, D.D.S.

  • General Practice Dentistry
  • Boerne, TX
  • NPI 1538447685
  NPD Authorized official
• Reg Holton Cully, D.C.

  • Rehabilitation Chiropractor
  • Boerne, TX
  • NPI 1043595929
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1756944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759449600000",
    "number": "1093695660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 UPPER BALCONES RD",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780068545",
            "telephone_number": "830-446-5510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 COUGHRAN RD STE 302",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780068103",
            "telephone_number": "830-446-5510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRANIOMANDIBULAR ASSOCIATES OF SAN ANTONIO PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-04",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A",
        "authorized_official_last_name": "CULLY",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "830-446-5510"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Boerne, TX
• Providers in Boerne, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.