Healthcare Provider Details

I. General information

NPI: 1538222583
Provider Name (Legal Business Name): JENNIFER GUIDRY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 MURFREESBORO PIKE
NASHVILLE TN
37210-2842
US

IV. Provider business mailing address

4018 LEALAND LN
NASHVILLE TN
37204-4002
US

V. Phone/Fax

Practice location:
  • Phone: 615-256-7543
  • Fax: 615-256-8895
Mailing address:
  • Phone: 504-452-2123
  • Fax: 615-256-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number9962
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: