MEDICARE: LITTLE MANHATTAN PEDIATRIC DENTISTRY,PLLC

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	1223P0221X	Pediatric Dentistry	22644	TX

General Provider Information

NPI Number	:	1508122094
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LITTLE MANHATTAN PEDIATRIC DENTISTRY,PLLC

Provider Business Mailing Address
First Line	:	423 W. HIGHWAY 495
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-9998
Country	:	US
Telephone Number	:	956-537-6764
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 W. HIGHWAY 495
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-9998
Country	:	US
Telephone Number	:	956-537-6764
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. SERGIO IVAN GUZMAN
Credential	:
Telephone Number	:	956-607-0732

Provider Enumeration Date	:	04/09/2012
Last Update Date	:	04/09/2012

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