Provider Demographics
NPI:1619007622
Name:GUZMAN, LOUIS J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:GUZMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6322
Mailing Address - Country:US
Mailing Address - Phone:516-379-6436
Mailing Address - Fax:
Practice Address - Street 1:2174 HEWLETT AVE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3606
Practice Address - Country:US
Practice Address - Phone:516-378-7203
Practice Address - Fax:513-378-5116
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA046542-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice