Provider Demographics
NPI:1487984563
Name:GUERRERO, REBECCA P (DDS)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:P
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:P
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:390 MUTTONTOWN RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2315
Mailing Address - Country:US
Mailing Address - Phone:516-364-2114
Mailing Address - Fax:516-364-2114
Practice Address - Street 1:390 MUTTONTOWN RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-2315
Practice Address - Country:US
Practice Address - Phone:516-364-2114
Practice Address - Fax:516-364-2114
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034550122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist