| Edinburg Dental, Pllc | |
|
423 W Fm 495 San Juan TX 78589-3717 | |
| (956) 537-6764 | |
| Not Available |
| Full Name | Edinburg Dental, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 423 W Fm 495, San Juan, Texas |
| Authorized Official Name and Position | Sergio Ivan Guzman (PEDIATRIC DENTIST/OWNER) |
| Authorized Official Contact | 9565376764 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edinburg Dental, Pllc Po Box 102 San Juan TX 78589-0102 Ph: (956) 537-6764 | Edinburg Dental, Pllc 423 W Fm 495 San Juan TX 78589-3717 Ph: (956) 537-6764 |
| NPI Number | 1104364165 |
|---|---|
| Provider Enumeration Date | 02/09/2017 |
| Last Update Date | 02/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104364165 | NPI | - | NPPES |
| 802626200 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 22644 (Texas) | Primary |
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