Provider Demographics
NPI:1568909455
Name:GUALTIERI, PAUL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:GUALTIERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BUCKSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04416-4612
Mailing Address - Country:US
Mailing Address - Phone:207-469-7371
Mailing Address - Fax:207-469-7306
Practice Address - Street 1:110 BROADWAY
Practice Address - Street 2:
Practice Address - City:BUCKSPORT
Practice Address - State:ME
Practice Address - Zip Code:04416-4612
Practice Address - Country:US
Practice Address - Phone:207-469-7371
Practice Address - Fax:207-469-7306
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0000001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice