Provider Demographics
NPI:1578024691
Name:GUERGUIS PROFESSIONAL DENTAL, INC.
Entity type:Organization
Organization Name:GUERGUIS PROFESSIONAL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IHAAB
Authorized Official - Middle Name:WADIE
Authorized Official - Last Name:GUERGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-926-6502
Mailing Address - Street 1:12657 166TH ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2101
Mailing Address - Country:US
Mailing Address - Phone:562-926-6502
Mailing Address - Fax:
Practice Address - Street 1:12657 166TH ST
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2101
Practice Address - Country:US
Practice Address - Phone:562-926-6502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental