Provider Demographics
NPI:1730487976
Name:GUZZARDI, JOSEPH ROSS
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ROSS
Last Name:GUZZARDI
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 1:25 QUARRY KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-7142
Mailing Address - Country:US
Mailing Address - Phone:860-895-7784
Mailing Address - Fax:
Practice Address - Street 1:733 TERRYVILLE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4034
Practice Address - Country:US
Practice Address - Phone:860-584-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0109051223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry