MEDICARE: DR. PETER JOSEPH GUIDA D.D.S.

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	007722	CT

General Provider Information

NPI Number	:	1588788459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER JOSEPH GUIDA D.D.S.

Provider Business Mailing Address
First Line	:	7 FOSTER DR
Second Line	:
City	:	ELLINGTON
State	:	CT
Zip	:	06029-2631
Country	:	US
Telephone Number	:	860-872-0102
Fax Number	:	860-644-9853

Provider Business Practice Location Address
First Line	:	469 BUCKLAND RD
Second Line	:
City	:	SOUTH WINDSOR
State	:	CT
Zip	:	06074-3737
Country	:	US
Telephone Number	:	860-644-2340
Fax Number	:	860-644-9853

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

Provider Enumeration Date	:	03/18/2007
Last Update Date	:	07/08/2007

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