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General NPI Number Information
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NPI Number | 1013668094
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Entity Type | Organization
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Legal Business Name | HEROES WESLACO PLLC
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 915 E EXPRESSWAY 83
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City | WESLACO
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State | TX
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Zip | 78599-4619
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Country | US
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Telephone | 956-800-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 S MCCOLL RD
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City | EDINBURG
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State | TX
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Zip | 78539-9739
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Country | US
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Telephone | 956-800-1060
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Fax | 956-800-1061
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Authorized Official
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Title or Position | OWNER
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Name | DR. SERGIO IVAN GUZMAN
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Credential | D.D.S
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Telephone | 956-607-0732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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