Provider Demographics
NPI:1447457288
Name:GUERRERO, ESTELA DEL CARMEN (DDS)
Entity type:Individual
Prefix:MRS
First Name:ESTELA
Middle Name:DEL CARMEN
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ESTELA
Other - Middle Name:
Other - Last Name:GUERRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:266 FORT LEE RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3904
Mailing Address - Country:US
Mailing Address - Phone:347-465-2665
Mailing Address - Fax:
Practice Address - Street 1:218 AUTUMN ST.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-815-0053
Practice Address - Fax:973-815-0024
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051757-11223G0001X
NJ22D102285700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124001Medicaid