Healthcare Provider Details

I. General information

NPI: 1457457368
Provider Name (Legal Business Name): DAVID VERNON GUZEK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 AIRPORT ROAD
PORTAGE IN
46368-5107
US

IV. Provider business mailing address

3465 AIRPORT ROAD
PORTAGE IN
46368-5107
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-2727
  • Fax: 219-763-0126
Mailing address:
  • Phone: 219-763-2727
  • Fax: 219-763-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12009122
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: