Healthcare Provider Details

I. General information

NPI: 1437769924
Provider Name (Legal Business Name): VICTORIA GUZMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2020
Last Update Date: 08/09/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 N HENDERSON DR
GARDEN CITY KS
67846-3624
US

IV. Provider business mailing address

2711 N KOSTER ST
GARDEN CITY KS
67846-3637
US

V. Phone/Fax

Practice location:
  • Phone: 620-275-4949
  • Fax:
Mailing address:
  • Phone: 620-805-9991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61703
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: