# DE ZAVALA MODERN DENTISTRY, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** De Zavala Modern Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104475185
- **Authorized official:** DR. ROBERTO A. BENAVIDES DDS (OWNER)
- **Authorized official phone:** (210) 740-0645

## Contact information

- **Practice address:** 5215 DE ZAVALA RD STE 103, SAN ANTONIO, TX 78249-2985
- **Practice address phone:** (210) 740-0645
- **Practice address fax:** (210) 757-4067
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8206
- **Mailing address fax:** (303) 952-0892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 09/11/2019
- **Last updated:** 02/11/2022