Healthcare Provider Details

I. General information

NPI: 1972416030
Provider Name (Legal Business Name): JOSE MANUEL GUEVARA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MAIN ST
DANBURY CT
06810-2624
US

IV. Provider business mailing address

209 MAIN ST
DANBURY CT
06810-2624
US

V. Phone/Fax

Practice location:
  • Phone: 203-730-2917
  • Fax:
Mailing address:
  • Phone: 203-730-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14867
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: