Provider Demographics
NPI:1417686510
Name:GUZMAN ELIAS, REYBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:REYBERTO
Middle Name:
Last Name:GUZMAN ELIAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:REYBERTO
Other - Middle Name:
Other - Last Name:GUZMAN ELIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:5696 TUSCOLA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2738
Mailing Address - Country:US
Mailing Address - Phone:813-403-0455
Mailing Address - Fax:
Practice Address - Street 1:5696 TUSCOLA BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2738
Practice Address - Country:US
Practice Address - Phone:813-403-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist