Provider Demographics
NPI:1184841447
Name:GUISE, BRENT D (DMD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:D
Last Name:GUISE
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 1:150 CHAMBERSBURG ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1112
Mailing Address - Country:US
Mailing Address - Phone:717-334-6747
Mailing Address - Fax:717-334-0060
Practice Address - Street 1:150 CHAMBERSBURG ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-1112
Practice Address - Country:US
Practice Address - Phone:717-334-6747
Practice Address - Fax:717-334-0060
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024646L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice