Provider Demographics
NPI:1245567684
Name:GUERECA, MARIA DE JESUS (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:GUERECA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 962707
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-2707
Mailing Address - Country:US
Mailing Address - Phone:915-855-8874
Mailing Address - Fax:915-921-7842
Practice Address - Street 1:AVE. ESPEJO #79-A
Practice Address - Street 2:
Practice Address - City:CD JUAREZ
Practice Address - State:CHIH
Practice Address - Zip Code:32310
Practice Address - Country:MX
Practice Address - Phone:915-855-8874
Practice Address - Fax:915-921-7842
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ849463122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice