Healthcare Provider Details

I. General information

NPI: 1124686100
Provider Name (Legal Business Name): PATRICIA GUERRERO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 10/11/2023
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST
BOSTON MA
02111-1527
US

IV. Provider business mailing address

55 STATION LNDG APT 204W
MEDFORD MA
02155-5008
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6828
  • Fax:
Mailing address:
  • Phone: 786-546-6611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDF11827
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberDF11952
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: