Provider Demographics
NPI:1942490909
Name:GUTKOVICH, VITALY (DDS)
Entity Type:Individual
Prefix:
First Name:VITALY
Middle Name:
Last Name:GUTKOVICH
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 1:20 MILLPOND PARKWAY
Mailing Address - Street 2:DENTAL CARE SOLUTIONS
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950
Mailing Address - Country:US
Mailing Address - Phone:845-783-8741
Mailing Address - Fax:845-783-8529
Practice Address - Street 1:20 MILLPOND PARKWAY
Practice Address - Street 2:DENTAL CARE SOLUTIONS
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950
Practice Address - Country:US
Practice Address - Phone:845-783-8741
Practice Address - Fax:845-783-8529
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046579122300000X, 1223G0001X
FLDN17425122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice