Provider Demographics
NPI:1518065952
Name:GUERARD, JOSEPH WALTER (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:GUERARD
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 1:325 E MAIN ST
Mailing Address - Street 2:P.O.BOX 490
Mailing Address - City:WINNECONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54986-9703
Mailing Address - Country:US
Mailing Address - Phone:920-582-4343
Mailing Address - Fax:920-582-2625
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WINNECONNE
Practice Address - State:WI
Practice Address - Zip Code:54986-9703
Practice Address - Country:US
Practice Address - Phone:920-582-4343
Practice Address - Fax:920-582-2625
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33350900Medicaid