MEDICARE: DR. THOMAS J GUZZARDI 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	019-017197	IL

General Provider Information

NPI Number	:	1518960020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J GUZZARDI D.D.S.

Provider Business Mailing Address
First Line	:	2418 W INDIAN TRL
Second Line	:	STE E
City	:	AURORA
State	:	IL
Zip	:	60506-1590
Country	:	US
Telephone Number	:	630-907-2180
Fax Number	:	630-907-0789

Provider Business Practice Location Address
First Line	:	2418 W INDIAN TRL
Second Line	:	STE E
City	:	AURORA
State	:	IL
Zip	:	60506-1590
Country	:	US
Telephone Number	:	630-907-2180
Fax Number	:	630-907-0789

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	04/30/2012

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