Provider Demographics
NPI:1073752390
Name:CANJURA, GUILLERMO ALBERTO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:ALBERTO
Last Name:CANJURA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5365 WALNUT AVE.
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-902-1300
Mailing Address - Fax:909-902-1303
Practice Address - Street 1:5365 WALNUT AVE.
Practice Address - Street 2:SUITE E
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-902-1300
Practice Address - Fax:909-902-1303
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41592122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist