Healthcare Provider Details

I. General information

NPI: 1588137293
Provider Name (Legal Business Name): BIANCA LILLIAN GUIDETTI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 4TH ST
PERRIS CA
92570-2229
US

IV. Provider business mailing address

1520 WHITEHALL DR APT 206
DAVIE FL
33324-6640
US

V. Phone/Fax

Practice location:
  • Phone: 951-940-5855
  • Fax:
Mailing address:
  • Phone: 909-534-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number29715
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number103427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: