MEDICARE: DR. JENNIFER GUIDRY D.D.S.

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	1223P0221X	Pediatric Dentistry	9962	TN

General Provider Information

NPI Number	:	1538222583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER GUIDRY D.D.S.

Provider Business Mailing Address
First Line	:	4018 LEALAND LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-4002
Country	:	US
Telephone Number	:	504-452-2123
Fax Number	:	615-256-8895

Provider Business Practice Location Address
First Line	:	451 MURFREESBORO PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2842
Country	:	US
Telephone Number	:	615-256-7543
Fax Number	:	615-256-8895

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	11/17/2014

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