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General NPI Number Information
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NPI Number | 1205318441
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Entity Type | Organization
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Legal Business Name | DE ZAVALA DENTISTRY AND ORTHODONTICS PLLC
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 05/18/2022
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Provider Practice Location Address
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Address Line | 5230 DE ZAVALA RD STE 225
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1731
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Country | US
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Telephone | 210-696-0667
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Fax |
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Provider Business Mailing Address
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Address Line | 5230 DE ZAVALA RD STE 225
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City | SAN ANTONIO
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State | TX
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Zip | 78249-1731
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Country | US
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Telephone | 210-696-0667
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Fax |
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MARY PU
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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