Provider Demographics
NPI:1568628071
Name:ZACARIAS, JOSE CRUZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CRUZ
Last Name:ZACARIAS
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 1:1501 W SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5111
Mailing Address - Country:US
Mailing Address - Phone:956-781-5477
Mailing Address - Fax:
Practice Address - Street 1:1214 DIXIELAND RD
Practice Address - Street 2:SUITE #4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3351
Practice Address - Country:US
Practice Address - Phone:956-428-5322
Practice Address - Fax:956-428-7986
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202310301Medicaid