Healthcare Provider Details

I. General information

NPI: 1104781244
Provider Name (Legal Business Name): DAVID GUIDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S PENDLETON AVE STE 104
PENDLETON IN
46064-1106
US

IV. Provider business mailing address

16219 KENORA LN S
FORTVILLE IN
46040-9285
US

V. Phone/Fax

Practice location:
  • Phone: 765-713-5460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHADE16910
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: