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NPI Code Detail

MEDICARE: MARK CAVAZOS DDS

MEDICARE: MARK CAVAZOS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry15230TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134214489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK CAVAZOS DDS
Provider Business Mailing Address
First Line : PO BOX 2435
Second Line :
City : ALBANY
State : TX
Zip : 76430-8020
Country : US
Telephone Number : 325-762-2447
Fax Number :
Provider Business Practice Location Address
First Line : 725 PATE ST
Second Line :
City : ALBANY
State : TX
Zip : 76430-3225
Country : US
Telephone Number : 325-762-2447
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 04/03/2024

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