MEDICARE: DR. JASON C GUERRERO 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	019.027429	IL

General Provider Information

NPI Number	:	1720227861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON C GUERRERO DDS

Provider Business Mailing Address
First Line	:	122 S MICHIGAN AVENUE #1212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603
Country	:	US
Telephone Number	:	312-922-9595
Fax Number	:	312-922-9599

Provider Business Practice Location Address
First Line	:	122 S MICHIGAN AVE STE 1212
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-6262
Country	:	US
Telephone Number	:	312-922-9595
Fax Number	:	312-922-9599

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

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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