Provider Demographics
NPI:1780718536
Name:GUZMAN, ELSA (DMD)
Entity type:Individual
Prefix:DR
First Name:ELSA
Middle Name:
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2574
Mailing Address - Country:US
Mailing Address - Phone:617-522-8006
Mailing Address - Fax:
Practice Address - Street 1:594 CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2574
Practice Address - Country:US
Practice Address - Phone:617-522-8006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19837122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice