Provider Demographics
NPI:1871688978
Name:CAVAZOS, ROLAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:
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 1:504 BARCLAY ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5129
Mailing Address - Country:US
Mailing Address - Phone:210-431-7711
Mailing Address - Fax:210-431-9867
Practice Address - Street 1:504 BARCLAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5129
Practice Address - Country:US
Practice Address - Phone:210-431-7711
Practice Address - Fax:210-431-9867
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX176501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009208201Medicaid