Provider Demographics
NPI:1720088040
Name:GUTH, WILLIAM LEE (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEE
Last Name:GUTH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:LEE
Other - Last Name:GUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:501 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058
Mailing Address - Country:US
Mailing Address - Phone:541-298-4411
Mailing Address - Fax:541-298-7798
Practice Address - Street 1:501 E 7TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2677
Practice Address - Country:US
Practice Address - Phone:541-298-4411
Practice Address - Fax:541-298-7798
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD5892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150587Medicaid
ORU92590Medicare UPIN
U92590Medicare UPIN
ORR113882Medicare PIN