Provider Demographics
NPI:1124037460
Name:GUERRA, CHAD LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:LOUIS
Last Name:GUERRA
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 1:1300 N OAKLAND AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3008
Mailing Address - Country:US
Mailing Address - Phone:417-770-5145
Mailing Address - Fax:
Practice Address - Street 1:1300 N OAKLAND AVE STE B
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3008
Practice Address - Country:US
Practice Address - Phone:417-770-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6245250-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice