Provider Demographics
NPI:1891179222
Name:ALCAZAR, JEREMIAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMIAH
Middle Name:
Last Name:ALCAZAR
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 1:635 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-3603
Mailing Address - Country:US
Mailing Address - Phone:512-644-3860
Mailing Address - Fax:
Practice Address - Street 1:6830 E SAM HOUSTON PKWY N
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-7301
Practice Address - Country:US
Practice Address - Phone:713-451-8845
Practice Address - Fax:713-451-8937
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX311541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice