Provider Demographics
NPI:1417952011
Name:GUTTU, RONALD L (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:GUTTU
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 1:2359 MURPHY WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2343
Mailing Address - Country:US
Mailing Address - Phone:608-362-9391
Mailing Address - Fax:
Practice Address - Street 1:2359 MURPHY WOODS RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2343
Practice Address - Country:US
Practice Address - Phone:608-362-9391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33791000Medicaid
T90964Medicare UPIN
WI33791000Medicaid