Provider Demographics
NPI:1730596164
Name:MAGALLANES, VICTOR HUGO
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:HUGO
Last Name:MAGALLANES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W CASTLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5329
Mailing Address - Country:US
Mailing Address - Phone:832-652-8915
Mailing Address - Fax:
Practice Address - Street 1:1106 W EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-4640
Practice Address - Country:US
Practice Address - Phone:832-652-8915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice