MEDICARE: MISS VICTORIA 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	1223G0001X	General Practice Dentistry	61703	KS

General Provider Information

NPI Number	:	1437769924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VICTORIA GUZMAN DDS

Provider Business Mailing Address
First Line	:	2711 N KOSTER ST
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3637
Country	:	US
Telephone Number	:	620-805-9991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 N HENDERSON DR
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846-3624
Country	:	US
Telephone Number	:	620-275-4949
Fax Number	:

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

Provider Enumeration Date	:	08/09/2020
Last Update Date	:	08/09/2020

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