MEDICARE: DR. DAX ALEXANDER GUENTHER MD

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	208200000X	Plastic Surgery Physician	219506	MA

General Provider Information

NPI Number	:	1831170497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAX ALEXANDER GUENTHER MD

Provider Business Mailing Address
First Line	:	2 POND PARK RD STE 308
Second Line	:	COASTAL PLASTIC SURGERY LLC
City	:	HINGHAM
State	:	MA
Zip	:	02043-4354
Country	:	US
Telephone Number	:	781-740-7840
Fax Number	:	781-740-9840

Provider Business Practice Location Address
First Line	:	2 POND PARK RD STE 308
Second Line	:	COASTAL PLASTIC SURGERY LLC
City	:	HINGHAM
State	:	MA
Zip	:	02043-4354
Country	:	US
Telephone Number	:	781-740-7840
Fax Number	:	781-740-9840

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	05/06/2014

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