Provider Demographics
NPI:1245447366
Name:STAPPENBECK, CARLA GUZMAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:GUZMAN
Last Name:STAPPENBECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:MONIQUE
Other - Last Name:GUZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 TOWNE CENTER DR STE 500
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2034
Mailing Address - Country:US
Mailing Address - Phone:912-376-9296
Mailing Address - Fax:
Practice Address - Street 1:120 TOWNE CENTER DR STE 500
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-2034
Practice Address - Country:US
Practice Address - Phone:912-376-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0147411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry