Deidre East Guerrettaz, DDS
Individual provider Active NPI General Practice Dentistry · Indpls, IN
NPI 1164586269 · NPPES record last updated Mar 7, 2013
Key facts
- NPI
- 1164586269
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12008749 (IN)
- Practice address
- 4809 N Pennsylvania St
Indpls, IN 46205 - Phone
- (317) 283-5225
- NPI assigned
- Dec 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12008749 | IN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12008749 | IN | Yes |
Addresses
Primary practice location
4809 N Pennsylvania St
Indpls, IN 46205
Mailing address
4809 N Pennsylvania St
Indpls, IN 46205
Phone (317) 283-5225
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100120810A | Medicaid | IN |
Other providers in Indpls, IN
- Dianne Martin MD Professional Corporation
- Tara Elsner
- Cletis R Foster
- Tejuana Garnes
- Abbie Ann Grudzien
- Healthy Feet LLC
- David R Johnson
- Sarah Lynn Jones
- Elizabeth Anne Judd
- Joann Lichtenberg
All providers in Indpls, IN · General Practice Dentistry in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.