Provider Demographics
NPI:1083228308
Name:GUEVARRA DENTAL GROUP
Entity Type:Organization
Organization Name:GUEVARRA DENTAL GROUP
Other - Org Name:CORNING FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GUEVARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-410-4591
Mailing Address - Street 1:955 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1308
Mailing Address - Country:US
Mailing Address - Phone:530-410-4591
Mailing Address - Fax:530-893-2841
Practice Address - Street 1:480 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3451
Practice Address - Country:US
Practice Address - Phone:530-824-5165
Practice Address - Fax:530-824-5684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental