Individual
DR. JACK R. VIZUETE
Active
Individual
DR. JACK R. VIZUETE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
14375
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
14375
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1306284-03
—
TX
05
—
1306284-05
—
TX
01
—
742404710
TAX ID
TX
01
—
840368
UNITED CONCORDIA
TX
01
—
D14375
DELTA TX CHIPS
TX
Enumeration date
07/18/2005
Last updated
03/07/2023
Update your record
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