Healthcare Provider Details

I. General information

NPI: 1396009338
Provider Name (Legal Business Name): DAVID BURRELL GUTHRIE III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ENTERPRISE CT UNIT A276
LEXINGTON KY
40510-1034
US

IV. Provider business mailing address

3001 HAYFIELD DR
LOUISVILLE KY
40205-2809
US

V. Phone/Fax

Practice location:
  • Phone: 614-401-4415
  • Fax:
Mailing address:
  • Phone: 408-314-4968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL11540
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number9322
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9322
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: