Provider Demographics
NPI:1366767592
Name:GUERRIERO, ELLEN JANE (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:JANE
Last Name:GUERRIERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1537
Mailing Address - Country:US
Mailing Address - Phone:631-472-5880
Mailing Address - Fax:
Practice Address - Street 1:464 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1537
Practice Address - Country:US
Practice Address - Phone:631-472-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0392971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice