Provider Demographics
NPI:1376926113
Name:GUFFORD, JUSTIN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:S
Last Name:GUFFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17607 GOLD PLZ STE 108
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-5605
Mailing Address - Country:US
Mailing Address - Phone:402-934-5200
Mailing Address - Fax:
Practice Address - Street 1:17607 GOLD PLZ STE 108
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-5605
Practice Address - Country:US
Practice Address - Phone:402-934-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist