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General NPI Number Information
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NPI Number | 1316178684
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Entity Type | Organization
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Legal Business Name | MARK A. CAVAZOS, D.D.S., PLLC
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Dates
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Enumeration Date | 08/04/2009
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 3414 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78214-2606
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Country | US
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Telephone | 210-924-5008
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Fax | 210-924-5326
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Provider Business Mailing Address
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Address Line | 3414 ROOSEVELT AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78214-2606
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Country | US
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Telephone | 210-924-5008
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Fax | 210-924-5326
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | DR. MARK A CAVAZOS
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Credential | DDS
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Telephone | 210-924-5008
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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 | 15230
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License Number State | TX
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