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General NPI Number Information
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NPI Number | 1356819817
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Entity Type | Organization
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Legal Business Name | MICHAEL V. GUADIZ MPT, D.D.S. PC
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 1145 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60607-4221
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Country | US
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Telephone | 312-226-1537
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Fax | 312-226-1536
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Provider Business Mailing Address
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Address Line | 1145 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60607-4221
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Country | US
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Telephone | 312-226-1537
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Fax | 312-226-1536
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MICHAEL VINCENT GUADIZ
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Credential |
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Telephone | 312-226-1537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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