Provider Demographics
NPI:1740919331
Name:GUEVARA, EDUARDO (DDS)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:GUEVARA
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 1:5250 BLANCO RD # RC
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7017
Mailing Address - Country:US
Mailing Address - Phone:210-349-3368
Mailing Address - Fax:210-349-2743
Practice Address - Street 1:3715 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3514
Practice Address - Country:US
Practice Address - Phone:210-532-1166
Practice Address - Fax:210-922-1841
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX386291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty