Provider Demographics
NPI:1740384874
Name:BLAISE GUZZARDO DDS PC
Entity type:Organization
Organization Name:BLAISE GUZZARDO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAISE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GUZZARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-464-4442
Mailing Address - Street 1:94-71 217TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428
Mailing Address - Country:US
Mailing Address - Phone:718-464-4442
Mailing Address - Fax:718-464-4509
Practice Address - Street 1:94-71 217TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428
Practice Address - Country:US
Practice Address - Phone:718-464-4442
Practice Address - Fax:718-464-4509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty