Healthcare Provider Details

I. General information

NPI: 1871875997
Provider Name (Legal Business Name): MCPHERSON DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6019 MCPHERSON RD SUITE 5
LAREDO TX
78041-6178
US

IV. Provider business mailing address

6019 MCPHERSON RD SUITE 5
LAREDO TX
78041-6178
US

V. Phone/Fax

Practice location:
  • Phone: 956-717-8899
  • Fax:
Mailing address:
  • Phone: 956-717-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16711
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number17103
License Number StateTX

VIII. Authorized Official

Name: DR. MARIA GUERRA ZUNIGA
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 956-717-8899