Provider Demographics
NPI:1295068468
Name:DR. ERAN J. GUTKIN DMD PS
Entity type:Organization
Organization Name:DR. ERAN J. GUTKIN DMD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GUTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-283-0964
Mailing Address - Street 1:3203 W MCGRAW ST
Mailing Address - Street 2:201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-3236
Mailing Address - Country:US
Mailing Address - Phone:206-283-0964
Mailing Address - Fax:
Practice Address - Street 1:3203 W MCGRAW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98199-3236
Practice Address - Country:US
Practice Address - Phone:206-283-0964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60102369261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental