Provider Demographics
NPI:1831393008
Name:GUZMAN, AIXA (DMD)
Entity type:Individual
Prefix:
First Name:AIXA
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 1:2160 CAPITAL CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4391
Mailing Address - Country:US
Mailing Address - Phone:850-562-6111
Mailing Address - Fax:850-562-7263
Practice Address - Street 1:2160 CAPITAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4391
Practice Address - Country:US
Practice Address - Phone:850-681-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics