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General NPI Number Information
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NPI Number | 1588788459
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Entity Type | Individual
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Provider Name | PETER JOSEPH GUIDA D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 469 BUCKLAND RD
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City | SOUTH WINDSOR
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State | CT
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Zip | 06074-3737
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Country | US
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Telephone | 860-644-2340
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Fax | 860-644-9853
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Provider Business Mailing Address
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Address Line | 7 FOSTER DR
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City | ELLINGTON
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State | CT
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Zip | 06029-2631
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Country | US
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Telephone | 860-872-0102
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Fax | 860-644-9853
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 007722
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License Number State | CT
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