Provider Demographics
NPI:1376854760
Name:GUIRGUIS, AMBER VICKERS (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:VICKERS
Last Name:GUIRGUIS
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 1:4109 HIGH STAR LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-6737
Mailing Address - Country:US
Mailing Address - Phone:614-352-8448
Mailing Address - Fax:
Practice Address - Street 1:16631 COIT RD STE 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1795
Practice Address - Country:US
Practice Address - Phone:214-484-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice