Provider Demographics
NPI:1689705469
Name:JAMES KENT GUEBERT DDS PC
Entity Type:Organization
Organization Name:JAMES KENT GUEBERT DDS PC
Other - Org Name:JAMES KENT GUEBERT DDS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:GUEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-939-2520
Mailing Address - Street 1:498 BROWN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2324
Mailing Address - Country:US
Mailing Address - Phone:815-939-2520
Mailing Address - Fax:
Practice Address - Street 1:498 BROWN BLVD
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2324
Practice Address - Country:US
Practice Address - Phone:815-939-2520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty