Provider Demographics
NPI:1265183651
Name:KEITH L GUZAITIS DDS INC
Entity type:Organization
Organization Name:KEITH L GUZAITIS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:GUZAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-941-8398
Mailing Address - Street 1:188 N YORK ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2715
Mailing Address - Country:US
Mailing Address - Phone:630-941-8398
Mailing Address - Fax:630-941-8408
Practice Address - Street 1:188 N YORK ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2715
Practice Address - Country:US
Practice Address - Phone:630-941-8398
Practice Address - Fax:630-941-8408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty