Provider Demographics
NPI:1508122094
Name:LITTLE MANHATTAN PEDIATRIC DENTISTRY,PLLC
Entity Type:Organization
Organization Name:LITTLE MANHATTAN PEDIATRIC DENTISTRY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DR. SERGIO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-607-0732
Mailing Address - Street 1:423 W. HIGHWAY 495
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-9998
Mailing Address - Country:US
Mailing Address - Phone:956-537-6764
Mailing Address - Fax:
Practice Address - Street 1:423 W. HIGHWAY 495
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-9998
Practice Address - Country:US
Practice Address - Phone:956-537-6764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX226441223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty