Provider Demographics
NPI:1598811846
Name:GUTTMAN, JEROME ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ALAN
Last Name:GUTTMAN
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 1:211 CULVER BLVD
Mailing Address - Street 2:SUITE T
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7788
Mailing Address - Country:US
Mailing Address - Phone:310-827-5094
Mailing Address - Fax:310-821-3417
Practice Address - Street 1:211 CULVER BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7788
Practice Address - Country:US
Practice Address - Phone:310-827-5094
Practice Address - Fax:310-821-3417
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice