Provider Demographics
NPI:1619195013
Name:UTTERBACK, GEOFFREY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:M
Last Name:UTTERBACK
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 1:1360 S SAWBURG RD
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-3520
Mailing Address - Country:US
Mailing Address - Phone:330-821-6603
Mailing Address - Fax:330-821-2186
Practice Address - Street 1:1360 S SAWBURG RD
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-3520
Practice Address - Country:US
Practice Address - Phone:330-821-6603
Practice Address - Fax:330-821-2186
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0147991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice