Healthcare Provider Details

I. General information

NPI: 1407508823
Provider Name (Legal Business Name): NIKAURY GUZMAN PIBERNUS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30760 WOODWARD AVE
ROYAL OAK MI
48073-0918
US

IV. Provider business mailing address

PO BOX 1137
VILLALBA PR
00766-1137
US

V. Phone/Fax

Practice location:
  • Phone: 248-675-0946
  • Fax:
Mailing address:
  • Phone: 787-673-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2901602361
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3397
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: