Provider Demographics
NPI:1699333864
Name:K. GUYMON DENTAL, LLC
Entity type:Organization
Organization Name:K. GUYMON DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUYMON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-698-7632
Mailing Address - Street 1:1014 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1508
Mailing Address - Country:US
Mailing Address - Phone:801-698-7632
Mailing Address - Fax:
Practice Address - Street 1:1301 12TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4600
Practice Address - Country:US
Practice Address - Phone:801-698-7632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental