Provider Demographics
NPI:1043918873
Name:TREVINO, ALEJANDRA GISSEL
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:GISSEL
Last Name:TREVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEJANDRA
Other - Middle Name:GISSEL
Other - Last Name:TELLEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:111 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7727
Mailing Address - Country:US
Mailing Address - Phone:956-285-5440
Mailing Address - Fax:
Practice Address - Street 1:7329 N BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2228
Practice Address - Country:US
Practice Address - Phone:956-452-0585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX41541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program