Provider Demographics
NPI:1083341507
Name:MCGUIRE, CHARLA J (RDH; PHDH)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:J
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:RDH; PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 VANCE ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-1158
Mailing Address - Country:US
Mailing Address - Phone:217-663-7787
Mailing Address - Fax:
Practice Address - Street 1:502 SHAW AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2352
Practice Address - Country:US
Practice Address - Phone:217-465-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1376533513Medicaid