Provider Demographics
NPI:1851569768
Name:GREGORY P. GUTGSELL DDS & DARREN M PHIPPS DDS, PROF ASSN
Entity Type:Organization
Organization Name:GREGORY P. GUTGSELL DDS & DARREN M PHIPPS DDS, PROF ASSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GUTGSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-526-6655
Mailing Address - Street 1:P.O. BOX 265
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257
Mailing Address - Country:US
Mailing Address - Phone:603-526-6655
Mailing Address - Fax:603-526-6617
Practice Address - Street 1:125 NEWPORT ROAD
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257
Practice Address - Country:US
Practice Address - Phone:603-526-6655
Practice Address - Fax:603-526-6617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004691Medicaid