Organization
GUDELLA S. LICAROS, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUDELLA SAN JUAN LICAROS DDS (DENTIST)
(212) 787-2749
Entity
Organization
Contact information
Practice address
155 W 68TH ST, SUITE 226, NEW YORK, NY 10023-5808
(212) 787-2749
Mailing address
155 WEST 68TH STREET, SUITE 226, NEW YORK, NY 10023-5808
(212) 787-2749
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
043676
NY
Other
Enumeration date
09/04/2007
Last updated
09/04/2007
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