1760420525 NPI number — DR. MICHAEL JEFFREY GUEVARA D.D.S.

Table of content: DR. MICHAEL JEFFREY GUEVARA D.D.S. (NPI 1760420525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760420525 NPI number — DR. MICHAEL JEFFREY GUEVARA D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUEVARA
Provider First Name:
MICHAEL
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760420525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
59050 CYPRESS BAYOU LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACOMBE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70445-3600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-882-8047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1251 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-641-3587
Provider Business Practice Location Address Fax Number:
985-641-9417
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  2717 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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