MEDICARE: JONATHAN GUZMAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN29446	FL

General Provider Information

NPI Number	:	1386339240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GUZMAN DDS

Provider Business Mailing Address
First Line	:	18600 NW 87TH AVE UNIT 125
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3536
Country	:	US
Telephone Number	:	305-829-0100
Fax Number	:	305-829-7979

Provider Business Practice Location Address
First Line	:	18600 NW 87TH AVE UNIT 125
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33015-3536
Country	:	US
Telephone Number	:	305-829-0100
Fax Number	:	305-829-7979

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	07/26/2024

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