Healthcare Provider Details

I. General information

NPI: 1962072132
Provider Name (Legal Business Name): NICOLE L GUITO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9782 STATE HIGHWAY 16 S
PIPE CREEK TX
78063-5363
US

IV. Provider business mailing address

9782 STATE HIGHWAY 16 S
PIPE CREEK TX
78063-5363
US

V. Phone/Fax

Practice location:
  • Phone: 830-535-6200
  • Fax:
Mailing address:
  • Phone: 830-535-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37396
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: