Justin Anthony Dacy, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

21366 Issued in TX

Practice address

248 N Main St
#1
Boerne, TX 78006-2036

Phone

(830) 816-5102

Fax

(830) 331-9535

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1740360338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 N MAIN ST",
            "address_2": "#1",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062036",
            "telephone_number": "830-816-5102",
            "fax_number": "830-331-9535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 N MAIN ST",
            "address_2": "#1",
            "city": "BOERNE",
            "state": "TX",
            "postal_code": "780062036",
            "telephone_number": "830-816-5102",
            "fax_number": "830-331-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACY",
        "first_name": "JUSTIN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "21366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reg Holton Cully, D.C.
• Tara Lee Cully, D.D.S.
• John Ryan Cunningham, M.D.
• Curative Wound Care PLLC
• Cynthia R Tolbert MD PLLC
• Abiola Dairo
• Desiree Daniel, LPC
• Felicia Mae Danner
• Aditya Dave
• Peggy Davenport-Mendoza

• Periodontics in Boerne, TX
• Providers in Boerne, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.