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General NPI Number Information
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NPI Number | 1972902427
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Entity Type | Organization
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Legal Business Name | GREEN APPLE PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 08/21/2014
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 11601 US HWY 290 WEST SUITE 105
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City | AUSTIN
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State | TX
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Zip | 78737
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Country | US
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Telephone | 512-917-4550
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Fax |
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Provider Business Mailing Address
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Address Line | 904 WEST AVE SUITE 203
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City | AUSTIN
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State | TX
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Zip | 78701-2236
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Country | US
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Telephone | 210-287-1535
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST/MANAGING MEMBER
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Name | DR. MARIA EVELINA GUERRERO
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Credential | DDS
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Telephone | 210-287-1535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24128
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License Number State | TX
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