Provider Demographics
NPI:1386908291
Name:GUERRA, DANIEL ALEXIS (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALEXIS
Last Name:GUERRA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8205 SW 141ST ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1041
Mailing Address - Country:US
Mailing Address - Phone:305-742-6101
Mailing Address - Fax:
Practice Address - Street 1:8205 SW 141ST ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1041
Practice Address - Country:US
Practice Address - Phone:305-742-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist