Provider Demographics
NPI:1932373834
Name:GUSS, JERROLD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:
Last Name:GUSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 ERRINGER RD
Mailing Address - Street 2:STE.106
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3587
Mailing Address - Country:US
Mailing Address - Phone:805-527-9300
Mailing Address - Fax:
Practice Address - Street 1:1776 ERRINGER RD
Practice Address - Street 2:STE.106
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3587
Practice Address - Country:US
Practice Address - Phone:805-527-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist