Healthcare Provider Details

I. General information

NPI: 1316191794
Provider Name (Legal Business Name): RAPHAEL GUERRA D.D.S
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7318 MILITARY DR W
SAN ANTONIO TX
78227-2947
US

IV. Provider business mailing address

7318 MILITARY DR W
SAN ANTONIO TX
78227-2947
US

V. Phone/Fax

Practice location:
  • Phone: 210-673-1561
  • Fax: 210-675-7568
Mailing address:
  • Phone: 210-673-1561
  • Fax: 210-675-7568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14056
License Number StateTX

VIII. Authorized Official

Name: DR. RAPHAEL GUERRA
Title or Position: GENERAL DENTIST
Credential: D.D.S
Phone: 210-673-1561