Provider Demographics
NPI:1902377286
Name:GONZALEZ ZAMORA, SALVADOR ALEJANDRO
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:ALEJANDRO
Last Name:GONZALEZ ZAMORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11425 FLOR LIASTRIS
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-215-9491
Mailing Address - Fax:
Practice Address - Street 1:BLV. TOMAS FERNANDEZ #7930, EDIFICIO A, LOCAL C
Practice Address - Street 2:
Practice Address - City:CD. JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32460
Practice Address - Country:MX
Practice Address - Phone:656-207-3931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ67720541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice