Provider Demographics
NPI:1972694842
Name:DEGUZMAN, LUCY (DDS MS)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:DEGUZMAN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 CROSSROADS CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4908
Mailing Address - Country:US
Mailing Address - Phone:614-759-4446
Mailing Address - Fax:614-864-9778
Practice Address - Street 1:4409 CROSSROADS CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4908
Practice Address - Country:US
Practice Address - Phone:614-759-4446
Practice Address - Fax:614-864-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH203851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics