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General NPI Number Information
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NPI Number | 1851602734
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Entity Type | Individual
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Provider Name | CARLO ENRICO GUEVARA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2010
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 2600 EAST COMMERCIAL BLVD SUITE 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 954-566-0300
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Fax | 954-566-9066
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Provider Business Mailing Address
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Address Line | 2600 EAST COMMERCIAL BLVD SUITE 200
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308
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Country | US
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Telephone | 954-566-0300
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Fax | 954-566-9066
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | ME126871
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN20097
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License Number State | FL
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