Provider Demographics
NPI:1205936978
Name:ST JOHN, CHARLES GUERIN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:GUERIN
Last Name:ST JOHN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:MA
Mailing Address - Zip Code:01226-1642
Mailing Address - Country:US
Mailing Address - Phone:413-684-1240
Mailing Address - Fax:
Practice Address - Street 1:251 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1642
Practice Address - Country:US
Practice Address - Phone:413-684-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA134581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10161OtherBLUE CROSS BLUE SHIELD