Provider Demographics
NPI:1124296256
Name:GUZMAN, MARCELA D (DDS)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:D
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 BUENAVENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7865
Mailing Address - Country:US
Mailing Address - Phone:407-344-2400
Mailing Address - Fax:407-344-1728
Practice Address - Street 1:10045 OAKSIDE CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-5938
Practice Address - Country:US
Practice Address - Phone:407-370-3236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice