Provider Demographics
NPI:1780495267
Name:ANGUIANO ANGUIANO, BERHA (DDS)
Entity type:Individual
Prefix:DR
First Name:BERHA
Middle Name:
Last Name:ANGUIANO ANGUIANO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 GATEWAY WEST, SPC 520, PMB 85
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2916 COYOACAN
Practice Address - Street 2:
Practice Address - City:JUAREZ
Practice Address - State:MEXICO
Practice Address - Zip Code:32300
Practice Address - Country:MX
Practice Address - Phone:915-631-5260
Practice Address - Fax:915-613-5260
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ75458641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice