Provider Demographics
NPI:1851021299
Name:MCGUFFIN, VICTORIA BRIANNA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:BRIANNA
Last Name:MCGUFFIN
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 1:2436 MIMOSA CIR
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-6702
Mailing Address - Country:US
Mailing Address - Phone:956-735-5042
Mailing Address - Fax:
Practice Address - Street 1:715 OLD AUSTIN HWY STE 400
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-5165
Practice Address - Country:US
Practice Address - Phone:512-212-9803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-16
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist