Healthcare Provider Details

I. General information

NPI: 1518960020
Provider Name (Legal Business Name): THOMAS J GUZZARDI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 04/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 W INDIAN TRL STE E
AURORA IL
60506-1590
US

IV. Provider business mailing address

2418 W INDIAN TRL STE E
AURORA IL
60506-1590
US

V. Phone/Fax

Practice location:
  • Phone: 630-907-2180
  • Fax: 630-907-0789
Mailing address:
  • Phone: 630-907-2180
  • Fax: 630-907-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-017197
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: