Provider Demographics
NPI:1891178877
Name:JOSEPH A GUROS
Entity Type:Organization
Organization Name:JOSEPH A GUROS
Other - Org Name:FORT DENTAL CARE, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-563-6373
Mailing Address - Street 1:501 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1202
Mailing Address - Country:US
Mailing Address - Phone:920-563-6373
Mailing Address - Fax:920-563-8796
Practice Address - Street 1:501 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1202
Practice Address - Country:US
Practice Address - Phone:920-563-6373
Practice Address - Fax:920-563-8796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001533-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty