Organization
SALEM STREET DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN GUZE DMD (PRESIDENT)
(617) 721-0707
Entity
Organization
Contact information
Practice address
15 SALEM ST, WORCESTER, MA 01608-2006
(617) 721-0707
Mailing address
15 SALEM ST, WORCESTER, MA 01608-2006
(617) 721-0707
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN21851
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN21851
DENTAL LICENSE
—
Enumeration date
08/14/2014
Last updated
08/14/2014
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