Healthcare Provider Details

I. General information

NPI: 1386881233
Provider Name (Legal Business Name): DR. FABIO DURZZO DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 ARTURO PLAZA COAHUILA SUITE 1-B SECOND FLOOR
PROGRESO TAMAULIPAS
88810
MX

IV. Provider business mailing address

453 SERG LOOP
ALAMO TX
78516-7285
US

V. Phone/Fax

Practice location:
  • Phone: 956-325-9795
  • Fax:
Mailing address:
  • Phone: 956-325-9795
  • Fax: 956-783-5162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: BEATRIZ CRUZ
Title or Position: OWNER
Credential:
Phone: 956-325-9795