Individual
GUARIONEX DECASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., P.A.
Contact information
Practice address
5917 W 12TH ST, SUITE A, LITTLE ROCK, AR 72204-1608
(501) 663-8307
(501) 663-8308
Mailing address
5917 W 12TH ST, SUITE A, LITTLE ROCK, AR 72204-1608
(501) 663-8307
(501) 663-8308
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3449
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3449
DELTA DENTAL
AR
01
—
5X734
BLUE CROSS BLUE SHIELD
AR
Enumeration date
08/29/2006
Last updated
07/08/2007
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