Provider Demographics
NPI:1609430156
Name:GUIDO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:GUIDO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GUIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:765-448-4242
Mailing Address - Street 1:150 PROFESSIONAL CT STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5153
Mailing Address - Country:US
Mailing Address - Phone:765-448-4242
Mailing Address - Fax:765-807-3003
Practice Address - Street 1:150 PROFESSIONAL CT STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5153
Practice Address - Country:US
Practice Address - Phone:765-448-4242
Practice Address - Fax:765-807-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty