Provider Demographics
NPI:1992997282
Name:DE GUZMAN, JASMIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:
Last Name:DE GUZMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HEARD STREET
Mailing Address - Street 2:BLDG 556
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857
Mailing Address - Country:US
Mailing Address - Phone:808-438-5576
Mailing Address - Fax:
Practice Address - Street 1:146 CLARK ROAD
Practice Address - Street 2:BLDG 339
Practice Address - City:FORT SHAFTER
Practice Address - State:HI
Practice Address - Zip Code:96858
Practice Address - Country:US
Practice Address - Phone:808-438-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037235122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist