Provider Demographics
NPI:1639380595
Name:ZURITA, VICTOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:ZURITA
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 1:1720 YALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4032
Mailing Address - Country:US
Mailing Address - Phone:713-802-0449
Mailing Address - Fax:713-979-0248
Practice Address - Street 1:1720 YALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4032
Practice Address - Country:US
Practice Address - Phone:713-802-0449
Practice Address - Fax:713-979-0248
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154701223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135053002Medicaid
TX135053006Medicaid