Provider Demographics
NPI:1366603136
Name:GUCK, CHARLES C (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
Last Name:GUCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAIN STREET NORTH
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-1804
Mailing Address - Country:US
Mailing Address - Phone:203-264-8995
Mailing Address - Fax:203-267-6477
Practice Address - Street 1:201 MAIN STREET NORTH
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1804
Practice Address - Country:US
Practice Address - Phone:203-264-8995
Practice Address - Fax:203-267-6477
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist