Provider Demographics
NPI:1518090356
Name:DEGUZMAN, JOSEPH D (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N96W18221 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-1361
Mailing Address - Country:US
Mailing Address - Phone:262-250-7787
Mailing Address - Fax:262-250-7785
Practice Address - Street 1:N96W18221 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-1361
Practice Address - Country:US
Practice Address - Phone:262-250-7787
Practice Address - Fax:262-250-7785
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4076-0151223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics