Individual
CHARLES EDWARD GUEVARA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
BA DDS
Contact information
Practice address
175 ROUTE 59, BEN GILMAN SPRING VALLEY MEDICAL & DENTAL CLINIC, SPRING VALLEY, NY 10977-5231
(845) 426-5800
(845) 356-4467
Mailing address
318 STEILEN AVE, RIDGEWOOD, NJ 07450-2800
(201) 321-2516
(201) 670-6371
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
035435
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00826673
—
NY
Enumeration date
11/21/2005
Last updated
07/08/2007
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