Provider Demographics
NPI:1528181534
Name:GUTMAN, DALE GORDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:GORDON
Last Name:GUTMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BEECHCREST LANE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206
Mailing Address - Country:US
Mailing Address - Phone:859-331-3400
Mailing Address - Fax:
Practice Address - Street 1:155 BARNWOOD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2585
Practice Address - Country:US
Practice Address - Phone:859-331-3400
Practice Address - Fax:859-331-6429
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice