Provider Demographics
NPI:1043317688
Name:GUANGA, JOYCE PORTAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:PORTAL
Last Name:GUANGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HOLLY SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9030
Mailing Address - Country:US
Mailing Address - Phone:919-557-0361
Mailing Address - Fax:919-557-4303
Practice Address - Street 1:640 HOLLY SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9030
Practice Address - Country:US
Practice Address - Phone:919-557-0361
Practice Address - Fax:919-557-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC69041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice