Organization
EDINBURG DENTAL, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SERGIO IVAN GUZMAN DDS (PEDIATRIC DENTIST/OWNER)
(956) 537-6764
Entity
Organization
Contact information
Practice address
423 W FM 495, SAN JUAN, TX 78589-3717
(956) 537-6764
Mailing address
PO BOX 102, SAN JUAN, TX 78589-0102
(956) 537-6764
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
802626200
—
TX
Enumeration date
02/09/2017
Last updated
02/09/2017
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