Provider Demographics
NPI:1912033812
Name:COUTIN, GUSTAVO MANUEL (DDS)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:MANUEL
Last Name:COUTIN
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 1:1010 COMMON ST
Mailing Address - Street 2:SUITE #810
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2401
Mailing Address - Country:US
Mailing Address - Phone:504-529-2120
Mailing Address - Fax:504-524-5039
Practice Address - Street 1:1010 COMMON ST
Practice Address - Street 2:SUITE #810
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2401
Practice Address - Country:US
Practice Address - Phone:504-529-2120
Practice Address - Fax:504-524-5039
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3267122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist