Provider Demographics
NPI:1972023075
Name:GUILLERMO ARIZONA D.D.S PC
Entity Type:Organization
Organization Name:GUILLERMO ARIZONA D.D.S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIZONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-662-6940
Mailing Address - Street 1:2504 WASHINGTON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4998
Mailing Address - Country:US
Mailing Address - Phone:847-662-6940
Mailing Address - Fax:847-662-6589
Practice Address - Street 1:2504 WASHINGTON ST STE 100
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4998
Practice Address - Country:US
Practice Address - Phone:847-662-6940
Practice Address - Fax:847-662-6589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0236091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty