Provider Demographics
NPI:1275694697
Name:GUE, THOMAS B JR
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:GUE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4834
Mailing Address - Country:US
Mailing Address - Phone:803-536-6440
Mailing Address - Fax:803-268-9921
Practice Address - Street 1:695 LAUREL ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4834
Practice Address - Country:US
Practice Address - Phone:803-536-6440
Practice Address - Fax:803-268-9921
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC41041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4104Medicaid