Provider Demographics
NPI:1114471539
Name:KARLENE GUASTEFERRO D.D.S. OF CONNECTICUT, P.C.
Entity Type:Organization
Organization Name:KARLENE GUASTEFERRO D.D.S. OF CONNECTICUT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUASTEFERRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:800-397-6247
Mailing Address - Street 1:701 BROADWAY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3944
Mailing Address - Country:US
Mailing Address - Phone:800-397-6247
Mailing Address - Fax:
Practice Address - Street 1:701 BROADWAY
Practice Address - Street 2:SUITE 130
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-3944
Practice Address - Country:US
Practice Address - Phone:800-397-6247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2.011611122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty