Healthcare Provider Details

I. General information

NPI: 1649640285
Provider Name (Legal Business Name): PRISCILA GUZMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

8940 151ST AVE APT 1J
HOWARD BEACH NY
11414-1534
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7174
  • Fax:
Mailing address:
  • Phone: 347-216-2891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11508
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0583261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: