Provider Demographics
NPI:1013086537
Name:TREVINO, GEORGE ALBERTO (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALBERTO
Last Name:TREVINO
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 1:6990 S ZARZAMORA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224
Mailing Address - Country:US
Mailing Address - Phone:210-921-2288
Mailing Address - Fax:210-921-2278
Practice Address - Street 1:6990 S ZARZAMORA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224
Practice Address - Country:US
Practice Address - Phone:210-921-2288
Practice Address - Fax:210-921-2278
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX17643122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist