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General NPI Number Information
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NPI Number | 1013887066
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Entity Type | Organization
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Legal Business Name | THERESA GUANCI
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Dates
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Enumeration Date | 11/06/2025
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 400 COMMONWEALTH AVE # 104B
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City | BOSTON
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State | MA
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Zip | 02215-2813
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Country | US
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Telephone | 617-536-4620
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Fax | 617-536-3872
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Provider Business Mailing Address
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Address Line | 400 COMMONWEALTH AVE
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City | BOSTON
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State | MA
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Zip | 02215-2813
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Country | US
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Telephone | 617-536-4620
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Fax | 617-536-3872
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Authorized Official
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Title or Position | DENTIST
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Name | DR. THERESA L. GUANCI
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Credential | DMD
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Telephone | 617-536-4620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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