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NPI Code Detail

MEDICARE: JUSTIN R DEGUZMAN

MEDICARE: JUSTIN R DEGUZMAN
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
11223G0001XGeneral Practice Dentistry019.033804IL

General Provider Information

NPI Number : 1780315952
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN R DEGUZMAN
Provider Business Mailing Address
First Line : 2511 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-3883
Country : US
Telephone Number : 916-740-0436
Fax Number :
Provider Business Practice Location Address
First Line : 2511 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-3883
Country : US
Telephone Number : 916-740-0436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2022
Last Update Date : 06/20/2022

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