Healthcare Provider Details

I. General information

NPI: 1134061344
Provider Name (Legal Business Name): JEREMY MAURICE GUIDINGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 N COLUMBUS DR
GILBERT AZ
85234-8000
US

IV. Provider business mailing address

1027 N COLUMBUS DR
GILBERT AZ
85234-8000
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-9559
  • Fax:
Mailing address:
  • Phone: 630-864-9559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number001971-2025
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: