Provider Demographics
NPI:1710255914
Name:PATRICIA A. GUERRERO, DDS, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:PATRICIA A. GUERRERO, DDS, A PROFESSIONAL CORP
Other - Org Name:EVERBRIGHT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-513-1435
Mailing Address - Street 1:27943 SECO CANYON RD # 103
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3872
Mailing Address - Country:US
Mailing Address - Phone:661-513-1435
Mailing Address - Fax:
Practice Address - Street 1:27730 MCBEAN PKWY
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-1430
Practice Address - Country:US
Practice Address - Phone:661-513-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty