Provider Demographics
NPI:1154541506
Name:GIACOPUZZI, GUY GERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:GUY
Middle Name:GERALD
Last Name:GIACOPUZZI
Suffix:
Gender:M
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:CEDAR GLEN
Mailing Address - State:CA
Mailing Address - Zip Code:92321-0068
Mailing Address - Country:US
Mailing Address - Phone:909-337-9879
Mailing Address - Fax:
Practice Address - Street 1:29099 HOSPITAL ROAD
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-337-9879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist