Provider Demographics
NPI:1790358422
Name:GUEVARRA-SHAMS, GENELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENELLE
Middle Name:
Last Name:GUEVARRA-SHAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CAVERSHAM WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-6402
Mailing Address - Country:US
Mailing Address - Phone:916-300-5322
Mailing Address - Fax:
Practice Address - Street 1:7777 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2300
Practice Address - Country:US
Practice Address - Phone:916-822-8958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1065381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice