Individual
SERGIO IVAN GUZMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1317 ST CLAIRE BLVD STE A3, MISSION, TX 78572-6636
(956) 581-4403
(956) 581-2242
Mailing address
1317 ST CLAIRE BLVD STE A3, MISSION, TX 78572-6636
(956) 581-4403
(956) 581-2242
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
22644
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
186204704
—
TX
05
—
186204705
—
TX
01
—
22644
TSBDE
TX
01
—
B22644-01
CHIPS
TX
01
—
K0152252
DPS
TX
Enumeration date
07/25/2007
Last updated
09/06/2008
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