Provider Demographics
NPI:1114937323
Name:GUTHRIE, GARY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 E BRISTOL PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2737
Mailing Address - Country:US
Mailing Address - Phone:479-582-2630
Mailing Address - Fax:
Practice Address - Street 1:1188 N SALEM RD STE 10
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8808
Practice Address - Country:US
Practice Address - Phone:479-527-0707
Practice Address - Fax:479-527-0201
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2977122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist