Provider Demographics
NPI:1275062788
Name:GUAJARDO, GILBERT TROY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:TROY
Last Name:GUAJARDO
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 1:7625 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1492
Mailing Address - Country:US
Mailing Address - Phone:708-429-4770
Mailing Address - Fax:
Practice Address - Street 1:7625 W 159TH ST
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1492
Practice Address - Country:US
Practice Address - Phone:708-429-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0330351223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery