Provider Demographics
NPI:1982861266
Name:CHARLES GUTHRIE III DDS INC
Entity Type:Organization
Organization Name:CHARLES GUTHRIE III DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-631-3689
Mailing Address - Street 1:6800 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-1809
Mailing Address - Country:US
Mailing Address - Phone:405-631-3689
Mailing Address - Fax:405-631-3681
Practice Address - Street 1:6800 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1809
Practice Address - Country:US
Practice Address - Phone:405-631-3689
Practice Address - Fax:405-631-3681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty