Provider Demographics
NPI:1184002305
Name:SIMON GARZA JR. D.D.S. P.C.
Entity Type:Organization
Organization Name:SIMON GARZA JR. D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-445-7070
Mailing Address - Street 1:2501 W WILLIAM CANNON DR
Mailing Address - Street 2:BLDG 1 UNIT 101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5281
Mailing Address - Country:US
Mailing Address - Phone:512-445-7070
Mailing Address - Fax:512-445-7071
Practice Address - Street 1:2501 W WILLIAM CANNON DR
Practice Address - Street 2:BLDG 1 UNIT 101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5281
Practice Address - Country:US
Practice Address - Phone:512-445-7070
Practice Address - Fax:512-445-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty