Healthcare Provider Details

I. General information

NPI: 1447790134
Provider Name (Legal Business Name): EMMA JEANETTE GUZMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N OCEAN AVE
FREEPORT NY
11520
US

IV. Provider business mailing address

2353 FOSTER AVE APT 4C
BROOKLYN NY
11210-1157
US

V. Phone/Fax

Practice location:
  • Phone: 516-378-3280
  • Fax:
Mailing address:
  • Phone: 917-288-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number060002
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: