Provider Demographics
NPI:1952397358
Name:GUASTEFERRO, KARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:KARLENE
Middle Name:
Last Name:GUASTEFERRO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1550
Mailing Address - Country:US
Mailing Address - Phone:606-783-7701
Mailing Address - Fax:606-784-3701
Practice Address - Street 1:316 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1550
Practice Address - Country:US
Practice Address - Phone:606-783-7701
Practice Address - Fax:606-784-3701
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037109122300000X
DCDEN1001611122300000X
MI2901021809122300000X
KY115011223G0001X
DEG1-00013951223G0001X
WI1001042122300000X
NY043881122300000X
OH3024695122300000X, 122300000X
TNDS0000009935122300000X
IL019030610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA901101775Medicaid
TNQ04876Medicaid
NY01299669Medicaid