Provider Demographics
NPI:1871016329
Name:CAVAZOS, JOSEPH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:CAVAZOS
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 1:1108 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-4207
Mailing Address - Country:US
Mailing Address - Phone:409-935-6211
Mailing Address - Fax:
Practice Address - Street 1:1108 1ST ST
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-4207
Practice Address - Country:US
Practice Address - Phone:956-874-4642
Practice Address - Fax:409-935-6211
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice