Healthcare Provider Details

I. General information

NPI: 1386339240
Provider Name (Legal Business Name): JONATHAN GUZMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18600 NW 87TH AVE UNIT 125
HIALEAH FL
33015-3536
US

IV. Provider business mailing address

18600 NW 87TH AVE UNIT 125
HIALEAH FL
33015-3536
US

V. Phone/Fax

Practice location:
  • Phone: 305-829-0100
  • Fax: 305-829-7979
Mailing address:
  • Phone: 305-829-0100
  • Fax: 305-829-7979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: