Provider Demographics
NPI:1518667674
Name:GUTTMANN, CONNOR K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:K
Last Name:GUTTMANN
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:ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - Street 2:3551 ROGER BROOKE DR.
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:212-916-2549
Mailing Address - Fax:
Practice Address - Street 1:ORAL AND MAXILLOFACIAL SURGERY
Practice Address - Street 2:3551 ROGER BROOKE DR.
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-07
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13421569-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist