Provider Demographics
NPI:1922466895
Name:DENNIS J GUERRIERI OD INC
Entity Type:Organization
Organization Name:DENNIS J GUERRIERI OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUERRIERI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-758-4000
Mailing Address - Street 1:231 C ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4521
Mailing Address - Country:US
Mailing Address - Phone:530-758-4000
Mailing Address - Fax:530-758-4016
Practice Address - Street 1:231 C ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4521
Practice Address - Country:US
Practice Address - Phone:530-758-4000
Practice Address - Fax:530-758-4016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0084781Medicaid
CASD0084781Medicare PIN
CAT10695Medicare UPIN
CA0634330001Medicare NSC