Provider Demographics
NPI:1659503811
Name:GUERRA, MARIA CECILIA FERNANDEZ (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA CECILIA
Middle Name:FERNANDEZ
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 1:333 RICCIUTI DR
Mailing Address - Street 2:APT 124
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6287
Mailing Address - Country:US
Mailing Address - Phone:617-481-9399
Mailing Address - Fax:
Practice Address - Street 1:333 RICCIUTI DR
Practice Address - Street 2:APT 124
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6287
Practice Address - Country:US
Practice Address - Phone:617-481-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist