Provider Demographics
NPI:1689703407
Name:GUTGARTS, EDUARD M (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARD
Middle Name:M
Last Name:GUTGARTS
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 1:1510 N POINSETTIA PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3611
Mailing Address - Country:US
Mailing Address - Phone:323-851-7140
Mailing Address - Fax:323-851-6117
Practice Address - Street 1:1510 N POINSETTIA PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-3611
Practice Address - Country:US
Practice Address - Phone:323-851-7140
Practice Address - Fax:323-851-6117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice