Provider Demographics
NPI:1679687958
Name:MARTIN E. GUYER D.D.S. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARTIN E. GUYER D.D.S. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GUYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-775-6770
Mailing Address - Street 1:19551 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3998
Mailing Address - Country:US
Mailing Address - Phone:586-775-6770
Mailing Address - Fax:586-775-6855
Practice Address - Street 1:19551 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3998
Practice Address - Country:US
Practice Address - Phone:586-775-6770
Practice Address - Fax:586-775-6855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI84731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4012968Medicaid