Healthcare Provider Details

I. General information

NPI: 1396410106
Provider Name (Legal Business Name): HIZAMAR A ESCOBEDO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 SW WILSHIRE BLVD STE 435
BURLESON TX
76028-8724
US

IV. Provider business mailing address

1561 SW WILSHIRE BLVD STE 435
BURLESON TX
76028-8724
US

V. Phone/Fax

Practice location:
  • Phone: 817-933-3883
  • Fax:
Mailing address:
  • Phone: 817-933-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37677
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: