Healthcare Provider Details

I. General information

NPI: 1245567684
Provider Name (Legal Business Name): MARIA DE JESUS GUERECA D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. ESPEJO #79-A
CD JUAREZ CHIH
32310
MX

IV. Provider business mailing address

P.O. BOX 962707
EL PASO TX
79996-2707
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-8874
  • Fax: 915-921-7842
Mailing address:
  • Phone: 915-855-8874
  • Fax: 915-921-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number849463
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number849463
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: