Provider Demographics
NPI:1437824232
Name:GUERRA, FERNANDA VARGAS VALLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDA
Middle Name:VARGAS VALLE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 CRANBERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02576-1233
Mailing Address - Country:US
Mailing Address - Phone:407-574-9588
Mailing Address - Fax:
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARWICH
Practice Address - State:MA
Practice Address - Zip Code:02671-1221
Practice Address - Country:US
Practice Address - Phone:508-255-0557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18590821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice