Johnny Cardona Cavazos, DDS
Individual provider Active NPI General Practice Dentistry · Zapata, TX
NPI 1003921115 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003921115
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 17649 (TX)
- Practice address
- 409 Hidalgo Ave
Zapata, TX 78076-0465 - Phone
- (956) 765-4400
- Fax
- (956) 765-1122
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150330001215 | TX | Order and Referring Only - Dentist |
4587981659 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17649 | TX | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aah Smile, PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 17649 | TX | Yes |
Addresses
Primary practice location
409 Hidalgo Ave
Zapata, TX 78076-0465
Mailing address
409 Hidalgo Ave
P O Box 465
Zapata, TX 78076-0465
Phone (956) 765-4400
NPI Registry JSON
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1003921115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 HIDALGO AVE",
"address_2": "P O BOX 465",
"city": "ZAPATA",
"state": "TX",
"postal_code": "780760465",
"telephone_number": "956-765-4400",
"fax_number": "956-765-1122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "409 HIDALGO AVE",
"city": "ZAPATA",
"state": "TX",
"postal_code": "780760465",
"telephone_number": "956-765-4400",
"fax_number": "956-765-1122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAVAZOS",
"first_name": "JOHNNY",
"middle_name": "CARDONA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "17649",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Zapata, TX
- Andres Garcia Zuniga MD PA
- Bienvenidos Adult Day Care Inc
- Bienvenidos Adult Day Care Inc
- Eduardo Carlos Canova
- Lorena G Cantu
- Champion Care of Zapata, Inc
- Community Action Council of South Texas
- CVS Pharmacy Inc
- Daniel'S Pharmacy Inc
- Daniel'S Pharmacy Inc
All providers in Zapata, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.