Provider Demographics
NPI:1386881233
Name:DR. FABIO DURZZO DDS
Entity type:Organization
Organization Name:DR. FABIO DURZZO DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEATRIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-325-9795
Mailing Address - Street 1:453 SERG LOOP
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-7285
Mailing Address - Country:US
Mailing Address - Phone:956-325-9795
Mailing Address - Fax:956-783-5162
Practice Address - Street 1:192 ARTURO PLAZA COAHUILA
Practice Address - Street 2:SUITE 1-B SECOND FLOOR
Practice Address - City:PROGRESO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88810
Practice Address - Country:MX
Practice Address - Phone:956-325-9795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty