MEDICARE: SEAWAY DENTAL GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518598069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEAWAY DENTAL GROUP PLLC

Provider Business Mailing Address
First Line	:	2435 MILITARY ST BLDG 4
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6664
Country	:	US
Telephone Number	:	810-982-5334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2435 MILITARY ST BLDG 4
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-6664
Country	:	US
Telephone Number	:	810-982-5334
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CHESTER GUASS
Credential	:	DDS
Telephone Number	:	810-982-5334

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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