Provider Demographics
NPI:1790880912
Name:GUZMAN, ULISES ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ULISES
Middle Name:ANTONIO
Last Name:GUZMAN
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 1:10435 MIDTOWN PKWY UNIT 222
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7465
Mailing Address - Country:US
Mailing Address - Phone:904-755-2400
Mailing Address - Fax:
Practice Address - Street 1:620 COMMERCE CENTER DR
Practice Address - Street 2:UNIT 155
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8802
Practice Address - Country:US
Practice Address - Phone:904-483-3022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00136591223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBG 3944851OtherDEA