Healthcare Provider Details

I. General information

NPI: 1639380595
Provider Name (Legal Business Name): VICTOR ZURITA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 YALE ST
HOUSTON TX
77008-4032
US

IV. Provider business mailing address

1720 YALE ST
HOUSTON TX
77008-4032
US

V. Phone/Fax

Practice location:
  • Phone: 713-802-0449
  • Fax: 713-979-0248
Mailing address:
  • Phone: 713-802-0449
  • Fax: 713-979-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number15470
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15470
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: