Provider Demographics
NPI:1568403608
Name:CABAZA, JUDY S (DDS)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:S
Last Name:CABAZA
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 1:7272 WURZBACH RD STE 1004
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4804
Mailing Address - Country:US
Mailing Address - Phone:210-615-2319
Mailing Address - Fax:210-615-2338
Practice Address - Street 1:7272 WURZBACH RD
Practice Address - Street 2:SUITE #1201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-615-2319
Practice Address - Fax:210-615-2338
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179960606OtherAMERICAN DENTAL ASSOCIATI
TX160953902Medicaid