Provider Demographics
NPI:1366588360
Name:GUERRANT, GEORGE HIBLER (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:HIBLER
Last Name:GUERRANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52780 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3003
Mailing Address - Country:US
Mailing Address - Phone:937-626-6322
Mailing Address - Fax:
Practice Address - Street 1:165 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1199
Practice Address - Country:US
Practice Address - Phone:574-271-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010773A1223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200930870Medicaid