Provider Demographics
NPI:1013213131
Name:JEROME A GUTTMAN DENTAL PRACTICE, INC
Entity Type:Organization
Organization Name:JEROME A GUTTMAN DENTAL PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GUTTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-827-5094
Mailing Address - Street 1:211 CULVER BLVD
Mailing Address - Street 2:SUITE T
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7788
Mailing Address - Country:US
Mailing Address - Phone:310-827-5094
Mailing Address - Fax:310-821-3417
Practice Address - Street 1:211 CULVER BLVD
Practice Address - Street 2:SUITE T
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7788
Practice Address - Country:US
Practice Address - Phone:310-827-5094
Practice Address - Fax:310-821-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental