MEDICARE: JOSEPH WALTER GUERARD 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	122300000X	Dentist	5001817	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518065952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WALTER GUERARD D.D.S.

Provider Business Mailing Address
First Line	:	325 E MAIN ST
Second Line	:	P.O.BOX 490
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9703
Country	:	US
Telephone Number	:	920-582-4343
Fax Number	:	920-582-2625

Provider Business Practice Location Address
First Line	:	325 E MAIN ST
Second Line	:
City	:	WINNECONNE
State	:	WI
Zip	:	54986-9703
Country	:	US
Telephone Number	:	920-582-4343
Fax Number	:	920-582-2625

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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