Healthcare Provider Details

I. General information

NPI: 1639579626
Provider Name (Legal Business Name): KELLY GUTHRIE D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16443 SEGOVIA CIR S
FORT LAUDERDALE FL
33331-4622
US

IV. Provider business mailing address

16443 SEGOVIA CIR S
FORT LAUDERDALE FL
33331-4622
US

V. Phone/Fax

Practice location:
  • Phone: 954-347-2308
  • Fax:
Mailing address:
  • Phone: 954-347-2308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN20052
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberAL4787
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: