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General NPI Number Information
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NPI Number | 1740545144
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Entity Type | Organization
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Legal Business Name | COASTAL PLASTIC SURGERY, LLC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 05/06/2014
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Provider Practice Location Address
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Address Line | 2 POND PARK RD STE 308 COASTAL PLASTIC SURGERY LLC
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City | HINGHAM
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State | MA
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Zip | 02043-4354
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Country | US
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Telephone | 781-740-7840
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Fax | 781-740-9840
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Provider Business Mailing Address
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Address Line | 2 POND PARK RD STE 308 COASTAL PLASTIC SURGERY LLC
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City | HINGHAM
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State | MA
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Zip | 02043-4354
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Country | US
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Telephone | 781-740-7840
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Fax | 781-740-9840
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Authorized Official
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Title or Position | SOLE MBR
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Name | DR. DAX GUENTHER
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Credential | MD
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Telephone | 781-740-7840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 219506
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License Number State | MA
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