Provider Demographics
NPI:1720474786
Name:GUARINO, NICCOLE
Entity Type:Individual
Prefix:
First Name:NICCOLE
Middle Name:
Last Name:GUARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 JACQUELINE DR
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-1131
Mailing Address - Country:US
Mailing Address - Phone:203-982-0752
Mailing Address - Fax:
Practice Address - Street 1:161 EAST AVE
Practice Address - Street 2:SUITE # 201
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5710
Practice Address - Country:US
Practice Address - Phone:203-354-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007925124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist