Provider Demographics
NPI:1073645818
Name:GUERRERO, ELMER JOSEPH (DDS)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:JOSEPH
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ELMER
Other - Middle Name:JOSEPH
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2960 TONGASS AVE
Mailing Address - Street 2:SUITE #403
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5742
Mailing Address - Country:US
Mailing Address - Phone:907-228-4902
Mailing Address - Fax:907-228-5256
Practice Address - Street 1:2960 TONGASS AVE
Practice Address - Street 2:SUITE #403
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5742
Practice Address - Country:US
Practice Address - Phone:907-228-4902
Practice Address - Fax:907-228-5256
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0941Medicaid