Provider Demographics
NPI:1891956611
Name:GUAJARDO, GERARDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:GUAJARDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2802 GARTH RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3900
Mailing Address - Country:US
Mailing Address - Phone:281-427-7376
Mailing Address - Fax:
Practice Address - Street 1:2802 GARTH RD
Practice Address - Street 2:SUITE 311
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3900
Practice Address - Country:US
Practice Address - Phone:281-427-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics