Provider Demographics
NPI:1285770792
Name:RECINOS, GUILLERMO RICARDO (DMD)
Entity type:Individual
Prefix:DR
First Name:GUILLERMO
Middle Name:RICARDO
Last Name:RECINOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1914
Mailing Address - Country:US
Mailing Address - Phone:617-642-7296
Mailing Address - Fax:
Practice Address - Street 1:12 SEWALL ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-1914
Practice Address - Country:US
Practice Address - Phone:617-642-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN16947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist