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General NPI Number Information
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NPI Number | 1821460460
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Entity Type | Organization
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Legal Business Name | RICARDO C. GUILLEN, D.D.S., P.L.L.C.
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Dates
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Enumeration Date | 10/22/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 501 MOORE AVE
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City | PORTLAND
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State | TX
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Zip | 78374-1605
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Country | US
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Telephone | 361-643-7811
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Fax | 361-643-4028
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Provider Business Mailing Address
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Address Line | 501 MOORE AVE
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City | PORTLAND
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State | TX
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Zip | 78374-1605
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Country | US
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Telephone | 361-643-7811
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Fax | 361-643-4028
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICARDO C GUILLEN
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Credential | D.D.S.
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Telephone | 361-643-7811
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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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