Basic Information
| Provider Information | |||||||||
| NPI: | 1437358488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GUIRGUIS | ||||||||
| FirstName: | HANI | ||||||||
| MiddleName: | MAKRAM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9400 LAKE VICTORIA DR | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933126234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612041515 | ||||||||
| FaxNumber: | 6615885490 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 KING AVE. | ||||||||
| Address2: | |||||||||
| City: | CORCORAN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5599928800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 46261 | CA | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 46261 | 01 | CA | DENTIST | OTHER |