| Organization Name: | JEROME A GUTTMAN DENTAL PRACTICE, INC |
| NPI Number: | 1013213131 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEROME ALAN GUTTMAN (PRESIDENT) |
| Mailing Address: | 211 Culver Blvd Suite T Playa Del Rey |
| State: | CA US |
| Postal Code: | 902937788 |
| Phone Number: | 3108275094 |
| Fax Number: | 3108213417 |
| NPI Enumeration Date: | 02/07/2011 |
| NPI Last Update Date: | 02/07/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |