Basic Information
| Provider Information | |||||||||
| NPI: | 1639360001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLAN | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | PATRICIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GUZMAN | ||||||||
| OtherFirstName: | CLAUDIA | ||||||||
| OtherMiddleName: | PATRICIA | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2050 WORTH RD | ||||||||
| Address2: | US ARMY DENTAL COMMAND | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782347533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210835 | ||||||||
| FaxNumber: | 2102210824 | ||||||||
| Practice Location | |||||||||
| Address1: | 2050 WORTH RD | ||||||||
| Address2: | US ARMY DENTAL COMMAND | ||||||||
| City: | FORT SAM HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782347533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102210835 | ||||||||
| FaxNumber: | 2102210824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 23409 | TX | N | Dental Providers | Dentist | Periodontics | 122300000X | 23409 | TX | Y | Dental Providers | Dentist |
No ID Information.