Provider Demographics
NPI:1689260283
Name:MIGUEL GUERRA DDS INC
Entity Type:Organization
Organization Name:MIGUEL GUERRA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:GUERRA OLVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-813-5220
Mailing Address - Street 1:5907 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5225
Mailing Address - Country:US
Mailing Address - Phone:916-337-5877
Mailing Address - Fax:
Practice Address - Street 1:1831 EXPOSITION BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-5007
Practice Address - Country:US
Practice Address - Phone:916-337-5877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659695815Medicaid