Provider Demographics
NPI:1386220556
Name:DANIEL F. GUERRA DMD, LLC
Entity Type:Organization
Organization Name:DANIEL F. GUERRA DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GUERRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-550-2485
Mailing Address - Street 1:6955 MAGONA CT
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8554
Mailing Address - Country:US
Mailing Address - Phone:618-550-2485
Mailing Address - Fax:
Practice Address - Street 1:517 MAIN ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4103
Practice Address - Country:US
Practice Address - Phone:636-343-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental