Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 19498 | TX |
NPI | 1013030410 |
---|---|
Provider Name | Dr. Ricardo Mauro Garza JR. |
First Address | Katy, TX 77450-3934 |
Second Address | Katy, TX 77450-3934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 08/07/2007 |