Provider Demographics
NPI:1588660856
Name:ZUNIGA, JOHN R (DDS/PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:ZUNIGA
Suffix:
Gender:M
Credentials:DDS/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UTSW BILLING
Mailing Address - Street 2:P.O. BOX 845347
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0001
Mailing Address - Country:US
Mailing Address - Phone:214-645-0600
Mailing Address - Fax:214-645-2762
Practice Address - Street 1:ORAL AND MAXILLOFACIAL SURGERY
Practice Address - Street 2:5939 HARRY HINES BLVD, #210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-0001
Practice Address - Country:US
Practice Address - Phone:214-645-3999
Practice Address - Fax:214-645-3989
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT97084Medicare UPIN
NC241336Medicare ID - Type Unspecified