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General NPI Number Information
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NPI Number | 1306416557
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES GUZELIAN DMD
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Gender | Male
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Dates
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Enumeration Date | 06/30/2021
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 1555 MAIN ST
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City | WINDSOR
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State | CO
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Zip | 80550-5998
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Country | US
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Telephone | 970-460-4871
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Fax |
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Provider Business Mailing Address
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Address Line | 5220 BOARDWALK DR UNIT A31
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City | FORT COLLINS
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State | CO
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Zip | 80525-7313
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Country | US
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Telephone | 978-821-8705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DEN.00205060
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License Number State | CO
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