Basic Information
Provider Information
NPI: 1033556097
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LONGORIA
FirstName: AISSA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5999 DE ZAVALA RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782492236
CountryCode: US
TelephoneNumber: 2106911333
FaxNumber: 2105612599
Practice Location
Address1: 5999 DE ZAVALA RD
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782492236
CountryCode: US
TelephoneNumber: 2106911333
FaxNumber: 2105612599
Other Information
ProviderEnumerationDate: 05/31/2013
LastUpdateDate: 10/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X28909TXY Dental ProvidersDentist 

ID Information
IDTypeStateIssuerDescription
2890901TXTEXAS STATE BOARD OF DENTAL EXAMINERSOTHER


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