Provider Demographics
NPI:1003921115
Name:CAVAZOS, JOHNNY CARDONA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:CARDONA
Last Name:CAVAZOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 HIDALGO AVE
Mailing Address - Street 2:P O BOX 465
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-0465
Mailing Address - Country:US
Mailing Address - Phone:956-765-4400
Mailing Address - Fax:956-765-1122
Practice Address - Street 1:409 HIDALGO AVE
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076-0465
Practice Address - Country:US
Practice Address - Phone:956-765-4400
Practice Address - Fax:956-765-1122
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice