Provider Demographics
NPI:1568543916
Name:GUILLERMO, IVETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:
Last Name:GUILLERMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10768 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2493
Mailing Address - Country:US
Mailing Address - Phone:305-220-3777
Mailing Address - Fax:305-220-7845
Practice Address - Street 1:10768 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2493
Practice Address - Country:US
Practice Address - Phone:305-220-3777
Practice Address - Fax:305-220-7845
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN156141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice