Provider Demographics
NPI:1760420525
Name:GUEVARA, MICHAEL JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEFFREY
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59050 CYPRESS BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-3600
Mailing Address - Country:US
Mailing Address - Phone:985-882-8047
Mailing Address - Fax:
Practice Address - Street 1:1251 7TH ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2041
Practice Address - Country:US
Practice Address - Phone:985-641-3587
Practice Address - Fax:985-641-9417
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics