Provider Demographics
NPI:1194549675
Name:GUERECA ROMERO, JUAN CARLOS (DDS)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:GUERECA ROMERO
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 1:689 TANK FARM RD
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7077
Mailing Address - Country:US
Mailing Address - Phone:805-543-8440
Mailing Address - Fax:
Practice Address - Street 1:550 CANAL ST STE B
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3455
Practice Address - Country:US
Practice Address - Phone:805-543-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice