Healthcare Provider Details

I. General information

NPI: 1831393008
Provider Name (Legal Business Name): AIXA GUZMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 CAPITAL CIR STE 100
TALLAHASSEE FL
32308-4391
US

IV. Provider business mailing address

2160 CAPITAL CIR STE 100
TALLAHASSEE FL
32308-4391
US

V. Phone/Fax

Practice location:
  • Phone: 850-681-6115
  • Fax:
Mailing address:
  • Phone: 850-562-6111
  • Fax: 850-562-7263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN14240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: