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General NPI Number Information
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NPI Number | 1407255268
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Entity Type | Organization
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Legal Business Name | MARICEL B GUARIN-FORTIN DDS INC
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/18/2014
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Provider Practice Location Address
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Address Line | 1439 E COLORADO ST
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City | GLENDALE
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State | CA
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Zip | 91205-1511
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Country | US
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Telephone | 818-545-7270
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Fax |
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Provider Business Mailing Address
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Address Line | 1439 E COLORADO ST
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City | GLENDALE
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State | CA
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Zip | 91205-1511
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Country | US
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Telephone | 818-545-7270
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARICEL B GUARIN-FORTIN
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Credential | DDS
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Telephone | 818-545-7270
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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 | B46812
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License Number State | CA
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