Healthcare Provider Details

I. General information

NPI: 1336347012
Provider Name (Legal Business Name): JERONIMO GUZMAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MILITARY TRL SUITE 110
JUPITER FL
33458-7040
US

IV. Provider business mailing address

2782 RAVELLA WAY
PALM BEACH GARDENS FL
33410-2968
US

V. Phone/Fax

Practice location:
  • Phone: 561-743-8311
  • Fax: 561-744-6201
Mailing address:
  • Phone: 561-779-4536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN18006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: