MEDICARE: DR. SERENA GUERRERO PUGEDA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	B4306401	CA

General Provider Information

NPI Number	:	1801805635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERENA GUERRERO PUGEDA DMD

Provider Business Mailing Address
First Line	:	2370 MARITIME DRIVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-3639
Country	:	US
Telephone Number	:	916-446-7768
Fax Number	:	916-446-9014

Provider Business Practice Location Address
First Line	:	2370 MARITIME DRIVE
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-3639
Country	:	US
Telephone Number	:	916-446-7768
Fax Number	:	916-446-9014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/21/2022

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