Provider Demographics
NPI:1336274521
Name:ADVANCED ENDODONTICS OF HOUSTON
Entity Type:Organization
Organization Name:ADVANCED ENDODONTICS OF HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-266-5900
Mailing Address - Street 1:7700 SAN FELIPE
Mailing Address - Street 2:STE. 320
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1613
Mailing Address - Country:US
Mailing Address - Phone:713-266-5900
Mailing Address - Fax:713-266-1080
Practice Address - Street 1:7700 SAN FELIPE
Practice Address - Street 2:STE. 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1613
Practice Address - Country:US
Practice Address - Phone:713-266-5900
Practice Address - Fax:713-266-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7439393OtherAETNA
TX9551OtherNATIONAL PACIFIC DENTAL
TX1500668OtherMANAGED DENTAL GUARD
TX01421190OtherUNITED CONCORDIA
TX281727OtherCIGNA
TX51694OtherSAFEGUARD HEALTH