Provider Demographics
NPI:1053598268
Name:GUEVARA, ADRIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:
Last Name:GUEVARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ADRIANA
Other - Middle Name:
Other - Last Name:GUEVARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2816 E HARTFORD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-3147
Mailing Address - Country:US
Mailing Address - Phone:414-645-0365
Mailing Address - Fax:414-645-1052
Practice Address - Street 1:3520 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4175
Practice Address - Country:US
Practice Address - Phone:414-645-0365
Practice Address - Fax:414-645-1052
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4746-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist