Provider Demographics
NPI:1295922540
Name:JEROME A GUTTMAN DDS, INC
Entity type:Organization
Organization Name:JEROME A GUTTMAN DDS, 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:323-722-6766
Mailing Address - Street 1:319 VIA DE LA PAZ
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4631
Mailing Address - Country:US
Mailing Address - Phone:310-230-1024
Mailing Address - Fax:323-722-2022
Practice Address - Street 1:3301 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1536
Practice Address - Country:US
Practice Address - Phone:323-722-6766
Practice Address - Fax:323-722-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29600261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental