Healthcare Provider Details

I. General information

NPI: 1306416557
Provider Name (Legal Business Name): MICHAEL CHARLES GUZELIAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 MAIN ST
WINDSOR CO
80550-5998
US

IV. Provider business mailing address

5220 BOARDWALK DR UNIT A31
FORT COLLINS CO
80525-7313
US

V. Phone/Fax

Practice location:
  • Phone: 970-460-4871
  • Fax:
Mailing address:
  • Phone: 978-821-8705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205060
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: