Provider Demographics
NPI:1265778484
Name:RICHARD GUZHA DDS LLC
Entity type:Organization
Organization Name:RICHARD GUZHA DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZHA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:253-627-3100
Mailing Address - Street 1:2617 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-7204
Mailing Address - Country:US
Mailing Address - Phone:253-627-3100
Mailing Address - Fax:263-627-5100
Practice Address - Street 1:2617 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7204
Practice Address - Country:US
Practice Address - Phone:253-627-3100
Practice Address - Fax:263-627-5100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-15
Last Update Date:2012-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000082461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty