MEDICARE: DR. STEVEN CHARLES GUY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	044825	NY
2	1223P0300X	Periodontics	15589	OH
3	1223P0300X	Periodontics	8493	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	994825	OTHER	NY	DELTA DENTAL
3	890478	OTHER	NY	UNITED CONCORDIA

General Provider Information

NPI Number	:	1396722617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN CHARLES GUY DDS

Provider Business Mailing Address
First Line	:	205 ONEIDA STREET
Second Line	:	FULTON DENTAL HEALTH ASSO
City	:	FULTON
State	:	NY
Zip	:	13609
Country	:	US
Telephone Number	:	315-598-3700
Fax Number	:	315-592-4760

Provider Business Practice Location Address
First Line	:	1131 COMMERCE PARK DRIVE E
Second Line	:	WATERTOWN DENTAL HEALTH GROUP
City	:	WATERTOWN
State	:	NY
Zip	:	13601
Country	:	US
Telephone Number	:	315-788-1070
Fax Number	:	315-785-1039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	07/08/2007

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