Provider Demographics
NPI:1881169886
Name:ZAZUETA, ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:ZAZUETA
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:PO BOX 8156
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-8156
Mailing Address - Country:US
Mailing Address - Phone:477-564-1652
Mailing Address - Fax:
Practice Address - Street 1:2405 TRANSPORTATION AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-6664
Practice Address - Country:US
Practice Address - Phone:619-474-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice