Provider Demographics
NPI:1306021043
Name:J. G. DENTAL INC
Entity Type:Organization
Organization Name:J. G. DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:GUERIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-625-0543
Mailing Address - Street 1:124 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1919
Mailing Address - Country:US
Mailing Address - Phone:617-625-0543
Mailing Address - Fax:
Practice Address - Street 1:124 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1919
Practice Address - Country:US
Practice Address - Phone:617-625-0543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty