Provider Demographics
NPI:1457457368
Name:GUZEK, DAVID VERNON (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:VERNON
Last Name:GUZEK
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 1:3465 AIRPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-5107
Mailing Address - Country:US
Mailing Address - Phone:219-763-2727
Mailing Address - Fax:219-763-0126
Practice Address - Street 1:3465 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5107
Practice Address - Country:US
Practice Address - Phone:219-763-2727
Practice Address - Fax:219-763-0126
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice