Provider Demographics
NPI:1790757649
Name:MCGUIRE, DIEDRA S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIEDRA
Middle Name:S
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:77 QUAKER RIDGE RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-2808
Mailing Address - Country:US
Mailing Address - Phone:914-654-1859
Mailing Address - Fax:914-654-1912
Practice Address - Street 1:77 QUAKER RIDGE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2808
Practice Address - Country:US
Practice Address - Phone:914-654-1859
Practice Address - Fax:914-654-1912
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0392791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics