Provider Demographics
NPI:1982992418
Name:LAUZAN GUIA, MARILIAN (DMD)
Entity Type:Individual
Prefix:
First Name:MARILIAN
Middle Name:
Last Name:LAUZAN GUIA
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 1:2914 CENTRAL AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-3823
Mailing Address - Country:US
Mailing Address - Phone:352-304-0916
Mailing Address - Fax:
Practice Address - Street 1:2914 CENTRAL AVE APT 5
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-3823
Practice Address - Country:US
Practice Address - Phone:352-304-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 194491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice