Provider Demographics
NPI:1528462769
Name:ZEN DENTAL GROUP
Entity type:Organization
Organization Name:ZEN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN JR.
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-238-8207
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0015
Mailing Address - Country:US
Mailing Address - Phone:956-238-8207
Mailing Address - Fax:
Practice Address - Street 1:2514 W FREDDY GONZALEZ DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7339
Practice Address - Country:US
Practice Address - Phone:956-238-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty