Healthcare Provider Details

I. General information

NPI: 1720088040
Provider Name (Legal Business Name): WILLIAM LEE GUTH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BILL LEE GUTH DDS

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 7TH ST
THE DALLES OR
97058-2677
US

IV. Provider business mailing address

501 E 7TH ST
THE DALLES OR
97058
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-4411
  • Fax: 541-298-7798
Mailing address:
  • Phone: 541-298-4411
  • Fax: 541-298-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5892
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: