MEDICARE: BALTAZAR GUZMAN DDS PC

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	44596	CA

General Provider Information

NPI Number	:	1972993350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BALTAZAR GUZMAN DDS PC

Provider Business Mailing Address
First Line	:	2001 UNION ST STE 664
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4111
Country	:	US
Telephone Number	:	415-567-4600
Fax Number	:	415-921-2890

Provider Business Practice Location Address
First Line	:	2001 UNION ST STE 664
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-4111
Country	:	US
Telephone Number	:	415-567-4600
Fax Number	:	415-921-2890

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BALTAZAR GUZMAN
Credential	:	DDS, PC
Telephone Number	:	415-567-4600

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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