Healthcare Provider Details

I. General information

NPI: 1124213111
Provider Name (Legal Business Name): MARY ELIZABETH GUZEK D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 HIGH ST UNIT#1
CHARLESTOWN MA
02129-3023
US

IV. Provider business mailing address

69 HIGH ST UNIT #1
CHARLESTOWN MA
02129-3023
US

V. Phone/Fax

Practice location:
  • Phone: 917-386-8803
  • Fax: 617-337-5711
Mailing address:
  • Phone: 917-386-8803
  • Fax: 617-337-5711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number21996
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: