MEDICARE: ZEN DENTAL GROUP

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
1	1223G0001X	General Practice Dentistry		TX

General Provider Information

NPI Number	:	1528462769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZEN DENTAL GROUP

Provider Business Mailing Address
First Line	:	PO BOX 905
Second Line	:
City	:	MISSION
State	:	TX
Zip	:	78573-0015
Country	:	US
Telephone Number	:	956-238-8207
Fax Number	:

Provider Business Practice Location Address
First Line	:	2514 W FREDDY GONZALEZ DR
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-7339
Country	:	US
Telephone Number	:	956-238-8207
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	SAMUEL DURAN JR.
Credential	:	D.D.S.
Telephone Number	:	956-238-8207

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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