Healthcare Provider Details

I. General information

NPI: 1831170497
Provider Name (Legal Business Name): DAX ALEXANDER GUENTHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 POND PARK RD STE 308 COASTAL PLASTIC SURGERY LLC
HINGHAM MA
02043-4354
US

IV. Provider business mailing address

2 POND PARK RD STE 308 COASTAL PLASTIC SURGERY LLC
HINGHAM MA
02043-4354
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-7840
  • Fax: 781-740-9840
Mailing address:
  • Phone: 781-740-7840
  • Fax: 781-740-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number219506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: