Provider Demographics
NPI:1669635066
Name:JOSEPH D DEGUZMAN DDS MS SC
Entity Type:Organization
Organization Name:JOSEPH D DEGUZMAN DDS MS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DEGUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:262-250-7787
Mailing Address - Street 1:W172 N9723 DIVISION ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022
Mailing Address - Country:US
Mailing Address - Phone:262-250-7787
Mailing Address - Fax:262-250-7785
Practice Address - Street 1:W172 N9723 DIVISION ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-250-7787
Practice Address - Fax:262-250-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4076261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental