# GUDELLA S. LICAROS, DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376737288
- **Authorized official:** DR. GUDELLA SAN JUAN LICAROS DDS (DENTIST)
- **Authorized official phone:** (212) 787-2749

## Contact information

- **Practice address:** 155 W 68TH ST, SUITE 226, NEW YORK, NY 10023-5808
- **Practice address phone:** (212) 787-2749
- **Mailing address:** 155 WEST 68TH STREET, SUITE 226, NEW YORK, NY 10023-5808
- **Mailing address phone:** (212) 787-2749

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 043676 | NY | Yes |

## Other

- **Enumeration date:** 09/04/2007
- **Last updated:** 09/04/2007