Provider Demographics
NPI:1477083525
Name:AGUIRRE, RENE EDUARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:EDUARDO
Last Name:AGUIRRE
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 1:2772 GASTON AVE APT 1734
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-2759
Mailing Address - Country:US
Mailing Address - Phone:830-719-0600
Mailing Address - Fax:
Practice Address - Street 1:2645 E SOUTHLAKE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6834
Practice Address - Country:US
Practice Address - Phone:817-421-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist