Provider Demographics
NPI:1134217755
Name:CARR, GUTHRIE POORMAN (DDS,MS)
Entity type:Individual
Prefix:
First Name:GUTHRIE
Middle Name:POORMAN
Last Name:CARR
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2453
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE BRA
Mailing Address - State:IN
Mailing Address - Zip Code:47996-2453
Mailing Address - Country:US
Mailing Address - Phone:765-497-6453
Mailing Address - Fax:
Practice Address - Street 1:4900 US 231 SOUTH
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3443
Practice Address - Country:US
Practice Address - Phone:765-538-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008891A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics