Provider Demographics
NPI:1821640822
Name:GUILLEN RIVERA ORAL AND MAXILLOFACIAL SURGERY PLLC
Entity Type:Organization
Organization Name:GUILLEN RIVERA ORAL AND MAXILLOFACIAL SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUILLEN RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD/DDS
Authorized Official - Phone:915-283-4730
Mailing Address - Street 1:7100 WESTWIND DR STE 110-115
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1786
Mailing Address - Country:US
Mailing Address - Phone:915-283-4730
Mailing Address - Fax:915-283-6210
Practice Address - Street 1:7100 WESTWIND DR STE 110-115
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1786
Practice Address - Country:US
Practice Address - Phone:915-283-4730
Practice Address - Fax:915-283-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty