Provider Demographics
NPI:1902815020
Name:GUERRA DENTISTRY, P.A.
Entity Type:Organization
Organization Name:GUERRA DENTISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:OTHON
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-585-1250
Mailing Address - Street 1:6213 N. 1ST LANE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-878-6691
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH BRYAN ROAD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-585-1250
Practice Address - Fax:956-585-1257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21734261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171723301Medicaid