Provider Demographics
NPI:1063633071
Name:GUENGERICH, DAVID BRENT (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENT
Last Name:GUENGERICH
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 1:775 ROUTE 113
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1000
Mailing Address - Country:US
Mailing Address - Phone:215-723-2162
Mailing Address - Fax:215-723-6990
Practice Address - Street 1:775 ROUTE 113
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1000
Practice Address - Country:US
Practice Address - Phone:215-723-2162
Practice Address - Fax:215-723-6990
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0364851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice