Provider Demographics
NPI:1982724589
Name:RICHARD A. GUACCIO
Entity type:Organization
Organization Name:RICHARD A. GUACCIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-865-3050
Mailing Address - Street 1:124 E US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2117
Mailing Address - Country:US
Mailing Address - Phone:219-865-3050
Mailing Address - Fax:219-865-3431
Practice Address - Street 1:124 E US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2117
Practice Address - Country:US
Practice Address - Phone:219-865-3050
Practice Address - Fax:219-865-3431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120064501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherGENERAL DENTIST