Provider Demographics
NPI:1417142993
Name:GUERRA, MARIANO W (DDS)
Entity Type:Individual
Prefix:
First Name:MARIANO
Middle Name:W
Last Name:GUERRA
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 1:106 N SUNRISE AVE
Mailing Address - Street 2:SUITE B-10
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2906
Mailing Address - Country:US
Mailing Address - Phone:916-787-0631
Mailing Address - Fax:916-787-3277
Practice Address - Street 1:106 N SUNRISE AVE
Practice Address - Street 2:SUITE B-10
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2906
Practice Address - Country:US
Practice Address - Phone:916-787-0631
Practice Address - Fax:916-787-3277
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist