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General NPI Number Information
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NPI Number | 1932150802
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Entity Type | Organization
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Legal Business Name | AESTHETIC AND HEALTHY SMILE, PA
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4403 DAUGHERTY AVE
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City | LAREDO
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State | TX
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Zip | 78041-3848
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Country | US
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Telephone | 956-723-5533
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Fax | 956-723-7513
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Provider Business Mailing Address
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Address Line | 4403 DAUGHERTY AVE
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City | LAREDO
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State | TX
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Zip | 78041-3848
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Country | US
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Telephone | 956-723-5533
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Fax | 956-723-7513
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHNNY C CAVAZOS
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Credential | DDS
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Telephone | 956-723-5533
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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 | 17649
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License Number State | TX
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