Provider Demographics
NPI:1689995706
Name:GUTMAN, EDWARD G (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:GUTMAN
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 1:7600 OSLER DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7735
Mailing Address - Country:US
Mailing Address - Phone:410-321-5078
Mailing Address - Fax:
Practice Address - Street 1:7600 OSLER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7735
Practice Address - Country:US
Practice Address - Phone:410-321-5078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD40991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice