Provider Demographics
NPI:1740382845
Name:GUELAKIS, CHARLES F (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:GUELAKIS
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 1:1122 HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1654
Mailing Address - Country:US
Mailing Address - Phone:203-272-9960
Mailing Address - Fax:208-699-9403
Practice Address - Street 1:1122 HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1654
Practice Address - Country:US
Practice Address - Phone:203-272-9960
Practice Address - Fax:208-699-9403
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4174122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002041741Medicaid
CT190000380Medicare PIN