Provider Demographics
NPI:1306208376
Name:POZAS GUAJARDO, ALFONSO GERARDO (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:ALFONSO
Middle Name:GERARDO
Last Name:POZAS GUAJARDO
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 E TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7191
Mailing Address - Country:US
Mailing Address - Phone:956-440-8700
Mailing Address - Fax:
Practice Address - Street 1:2102 E TYLER AVE
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7191
Practice Address - Country:US
Practice Address - Phone:956-440-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327411223P0221X
IN12013472A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry