Provider Demographics
NPI:1356819817
Name:MICHAEL V. GUADIZ MPT, D.D.S. PC
Entity Type:Organization
Organization Name:MICHAEL V. GUADIZ MPT, D.D.S. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:GUADIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-226-1537
Mailing Address - Street 1:1145 W TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4221
Mailing Address - Country:US
Mailing Address - Phone:312-226-1537
Mailing Address - Fax:312-226-1536
Practice Address - Street 1:1145 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4221
Practice Address - Country:US
Practice Address - Phone:312-226-1537
Practice Address - Fax:312-226-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental