Healthcare Provider Details

I. General information

NPI: 1992228076
Provider Name (Legal Business Name): ARTHUR GUTNIK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N EDWARDS ST
NEWBERG OR
97132-2709
US

IV. Provider business mailing address

0650 SW GAINES ST APT 1902
PORTLAND OR
97239-4455
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7358
  • Fax:
Mailing address:
  • Phone: 605-201-3620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD10701
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: