Healthcare Provider Details

I. General information

NPI: 1790344406
Provider Name (Legal Business Name): LUIS GERARDO GUZMAN SUAREZ DDS, MS, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N COLLEGE ST STE D
AUBURN AL
36830-3030
US

IV. Provider business mailing address

670 N COLLEGE ST STE D
AUBURN AL
36830-3030
US

V. Phone/Fax

Practice location:
  • Phone: 334-209-1352
  • Fax: 334-460-9728
Mailing address:
  • Phone: 334-209-1352
  • Fax: 334-460-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0006625
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0006625
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: