MEDICARE: CHARLES GUTHRIE III DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	4828	OK

General Provider Information

NPI Number	:	1982861266
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES GUTHRIE III DDS INC

Provider Business Mailing Address
First Line	:	6800 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1809
Country	:	US
Telephone Number	:	405-631-3689
Fax Number	:	405-631-3681

Provider Business Practice Location Address
First Line	:	6800 S WESTERN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-1809
Country	:	US
Telephone Number	:	405-631-3689
Fax Number	:	405-631-3681

Authorized Official
Title or Position	:	CEO
Name	:	DR. CHARLES GUTHRIE III
Credential	:	DDS
Telephone Number	:	405-631-3689

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	06/23/2008

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