Provider Demographics
NPI:1497006233
Name:GUERRAFAMILYDENTISTRY,PLLC
Entity type:Organization
Organization Name:GUERRAFAMILYDENTISTRY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:YANIRA
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:956-500-5527
Mailing Address - Street 1:201 N FM 3167
Mailing Address - Street 2:SUITE 11-12
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6724
Mailing Address - Country:US
Mailing Address - Phone:956-263-1889
Mailing Address - Fax:
Practice Address - Street 1:201 N FM 3167
Practice Address - Street 2:SUITE 11-12
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-6724
Practice Address - Country:US
Practice Address - Phone:956-263-1889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-19
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty