MEDICARE: AAH SMILE, PC

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	1223G0001X	General Practice Dentistry	17649	TX

General Provider Information

NPI Number	:	1407809619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAH SMILE, PC

Provider Business Mailing Address
First Line	:	PO BOX 465
Second Line	:
City	:	ZAPATA
State	:	TX
Zip	:	78076-0465
Country	:	US
Telephone Number	:	956-765-4400
Fax Number	:	956-765-1122

Provider Business Practice Location Address
First Line	:	409 HIDALGO AVE
Second Line	:
City	:	ZAPATA
State	:	TX
Zip	:	78076
Country	:	US
Telephone Number	:	956-765-4400
Fax Number	:	956-765-1122

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHNNY CAVAZOS
Credential	:	DDS
Telephone Number	:	956-765-4400

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	08/22/2020

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