=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245778984
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SILGUERO DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2017
-----------------------------------------------------
Last Update Date | 02/08/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2605 W MILE 5 RD STE 1 BLD E
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78574-0968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-583-1000
-----------------------------------------------------
Fax | 956-583-8000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2605 W MILE 5 RD STE 1 BLD E
-----------------------------------------------------
City | MISSION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78574-0968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-583-1000
-----------------------------------------------------
Fax | 956-583-8000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING
-----------------------------------------------------
Name | GEORGE LUIKHAM
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 956-583-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------