Provider Demographics
NPI:1801861745
Name:ZAVALA, JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:ZAVALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1910 HERMITAGE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1998
Mailing Address - Country:US
Mailing Address - Phone:512-310-2444
Mailing Address - Fax:512-310-7303
Practice Address - Street 1:1910 HERMITAGE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1998
Practice Address - Country:US
Practice Address - Phone:512-310-2444
Practice Address - Fax:512-310-7303
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice