Provider Demographics
NPI:1518106467
Name:GUCCIONE, DWAYNE ANTHONY
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ANTHONY
Last Name:GUCCIONE
Suffix:
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 1:2929 CARLISLE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1084
Mailing Address - Country:US
Mailing Address - Phone:214-348-5557
Mailing Address - Fax:214-348-5898
Practice Address - Street 1:2929 CARLISLE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1084
Practice Address - Country:US
Practice Address - Phone:214-348-5557
Practice Address - Fax:214-348-5898
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program