Provider Demographics
NPI:1114074754
Name:GUBA, CARYN AMY (DDS)
Entity Type:Individual
Prefix:
First Name:CARYN
Middle Name:AMY
Last Name:GUBA
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 1:2563 WAYWARD WIND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-9445
Mailing Address - Country:US
Mailing Address - Phone:317-862-9347
Mailing Address - Fax:
Practice Address - Street 1:44 YORKSHIRE BLVD E
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-4223
Practice Address - Country:US
Practice Address - Phone:317-894-4253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice