Organization
GUARIONEX DECASTRO DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUARIONEX R DECASTRO DMD PA (DENTIST)
(501) 663-3334
Entity
Organization
Contact information
Practice address
5917 W 12TH ST STE A, LITTLE ROCK, AR 72204-1600
(501) 663-3334
Mailing address
5917 W 12TH ST STE A, LITTLE ROCK, AR 72204-1600
(501) 663-3334
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750499547
—
AR
Enumeration date
12/16/2020
Last updated
12/16/2020
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