Provider Demographics
NPI:1033556097
Name:LONGORIA, AISSA A (DDS)
Entity Type:Individual
Prefix:
First Name:AISSA
Middle Name:A
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5999 DE ZAVALA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2236
Mailing Address - Country:US
Mailing Address - Phone:210-691-1333
Mailing Address - Fax:210-561-2599
Practice Address - Street 1:5999 DE ZAVALA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2236
Practice Address - Country:US
Practice Address - Phone:210-691-1333
Practice Address - Fax:210-561-2599
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28909OtherTEXAS STATE BOARD OF DENTAL EXAMINERS