Provider Demographics
NPI:1558415141
Name:AGUERO, SUSANA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:R
Last Name:AGUERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:BARNETT
Other - Last Name:AGUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:50 HOLYOKE ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 HOLYOKE ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2709
Practice Address - Country:US
Practice Address - Phone:413-887-8318
Practice Address - Fax:413-534-0900
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0206717Medicaid