Provider Demographics
NPI:1376329458
Name:GUERRA, ELISSA (DDS)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:GUERRA
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 1:410 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-2636
Mailing Address - Country:US
Mailing Address - Phone:281-908-4784
Mailing Address - Fax:
Practice Address - Street 1:19507 NORTH FWY STE 522
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-6072
Practice Address - Country:US
Practice Address - Phone:281-602-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist