Provider Demographics
NPI:1003030172
Name:W PETER GUTHMANN DDS
Entity Type:Organization
Organization Name:W PETER GUTHMANN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:GUTHMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:802-888-3521
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:5 PARK ST
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661
Mailing Address - Country:US
Mailing Address - Phone:802-888-5973
Mailing Address - Fax:802-888-5973
Practice Address - Street 1:5 PARK ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661
Practice Address - Country:US
Practice Address - Phone:802-888-5973
Practice Address - Fax:802-888-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160000585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1821021908OtherNPI TYPE I CMS
VT585OtherLICENSE
VT0001771Medicaid