Provider Demographics
NPI:1558439679
Name:GUZAITIS, KEITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:GUZAITIS
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 1:188 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-941-8398
Mailing Address - Fax:630-941-8408
Practice Address - Street 1:188 N YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-941-8398
Practice Address - Fax:630-941-8408
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026441122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist