MEDICARE: DR. MARCELLA R GUZMAN D.D.S

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	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1245396126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLA R GUZMAN D.D.S

Provider Business Mailing Address
First Line	:	3236 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2512
Country	:	US
Telephone Number	:	773-276-0300
Fax Number	:	773-252-5994

Provider Business Practice Location Address
First Line	:	3236 W FULLERTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2512
Country	:	US
Telephone Number	:	773-276-0300
Fax Number	:	773-252-5994

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/09/2007

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