Provider Demographics
NPI:1164489787
Name:GUTARTS, ROSTISLAV R (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSTISLAV
Middle Name:R
Last Name:GUTARTS
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 1:5574 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2541
Mailing Address - Country:US
Mailing Address - Phone:440-842-4111
Mailing Address - Fax:
Practice Address - Street 1:5574 PEARL RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-2541
Practice Address - Country:US
Practice Address - Phone:440-842-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 02 14341223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics