Provider Demographics
NPI:1386339240
Name:GUZMAN, JONATHAN (DDS)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:GUZMAN
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 1:18600 NW 87TH AVE UNIT 125
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3536
Mailing Address - Country:US
Mailing Address - Phone:305-829-0100
Mailing Address - Fax:305-829-7979
Practice Address - Street 1:18600 NW 87TH AVE UNIT 125
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3536
Practice Address - Country:US
Practice Address - Phone:305-829-0100
Practice Address - Fax:305-829-7979
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-06
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty