1700047271 NPI number — DR. VANESA GUERRA CLEMENTS DDS

Table of content: DR. VANESA GUERRA CLEMENTS DDS (NPI 1700047271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700047271 NPI number — DR. VANESA GUERRA CLEMENTS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLEMENTS
Provider First Name:
VANESA
Provider Middle Name:
GUERRA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700047271
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9090 SKILLMAN ST STE 200C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-8263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-342-5757
Provider Business Mailing Address Fax Number:
214-340-4868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13331 PRESTON RD STE 1134
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-991-4867
Provider Business Practice Location Address Fax Number:
214-420-4859
Provider Enumeration Date:
06/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  24025 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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