Healthcare Provider Details

I. General information

NPI: 1841366648
Provider Name (Legal Business Name): JAMES GUADULUPE HESBROOK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 SOUTH BROADWAY ST.
ELSA TX
78543-0096
US

IV. Provider business mailing address

PO BOX 96
ELSA TX
78543-0096
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-1083
  • Fax:
Mailing address:
  • Phone: 956-262-1083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13888
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: