MEDICARE: DR. JUAN CARLOS GUERRA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11031801	TX

General Provider Information

NPI Number	:	1346453479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS GUERRA DDS

Provider Business Mailing Address
First Line	:	127 N FM 3167
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6211
Country	:	US
Telephone Number	:	956-487-4746
Fax Number	:	956-487-4468

Provider Business Practice Location Address
First Line	:	127 N FM 3167
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6211
Country	:	US
Telephone Number	:	956-263-1889
Fax Number	:	956-263-1943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	04/26/2022

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