Provider Demographics
NPI:1942411830
Name:DR EDUARD GUTGARTS DDS A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DR EDUARD GUTGARTS DDS A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTGARTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-851-7140
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
Practice Address - Country:US
Practice Address - Phone:323-851-7140
Practice Address - Fax:323-851-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA285641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty