Provider Demographics
NPI:1437355526
Name:ISGEMA CORP.
Entity Type:Organization
Organization Name:ISGEMA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUAJARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-928-7975
Mailing Address - Street 1:2404 COMMERCIAL AVE
Mailing Address - Street 2:STE G
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1703
Mailing Address - Country:US
Mailing Address - Phone:210-928-7975
Mailing Address - Fax:210-928-7977
Practice Address - Street 1:2404 COMMERCIAL AVE
Practice Address - Street 2:STE G
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1703
Practice Address - Country:US
Practice Address - Phone:210-928-7975
Practice Address - Fax:210-928-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty