Provider Demographics
NPI:1467133397
Name:GUILARTE-FERNANDEZ, HENRY
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:GUILARTE-FERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-5795
Mailing Address - Country:US
Mailing Address - Phone:505-480-3628
Mailing Address - Fax:
Practice Address - Street 1:1425 6TH ST NW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2365
Practice Address - Country:US
Practice Address - Phone:863-280-7101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN284401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice