Provider Demographics
NPI:1043428360
Name:CARUNUNGAN, THERESA GARRIDO (DMD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:GARRIDO
Last Name:CARUNUNGAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MAIN ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3302
Mailing Address - Country:US
Mailing Address - Phone:978-369-2877
Mailing Address - Fax:209-671-6510
Practice Address - Street 1:747 MAIN ST
Practice Address - Street 2:SUITE 211
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3302
Practice Address - Country:US
Practice Address - Phone:978-369-2877
Practice Address - Fax:209-671-6510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA179501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice