=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013387125
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL J GUERRINO, DDS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/01/2015
-----------------------------------------------------
Last Update Date | 10/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 E SANDFORD BLVD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-699-6568
-----------------------------------------------------
Fax | 914-699-8140
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 E SANDFORD BLVD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-4725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-699-6568
-----------------------------------------------------
Fax | 914-699-8140
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAUL J GUERRINO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 914-420-7083
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 040460
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------