Provider Demographics
NPI:1336240548
Name:GUTTSCHUSS, LOTHAR M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOTHAR
Middle Name:M
Last Name:GUTTSCHUSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4282 GOLDEN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6257
Mailing Address - Country:US
Mailing Address - Phone:530-622-1525
Mailing Address - Fax:
Practice Address - Street 1:4282 GOLDEN CENTER DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6257
Practice Address - Country:US
Practice Address - Phone:530-622-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics