Healthcare Provider Details

I. General information

NPI: 1861534224
Provider Name (Legal Business Name): STUART M GUTSCHE DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W LANCASTER AVE SUITE 2
PAOLI PA
19301-1776
US

IV. Provider business mailing address

159 W LANCASTER AVE SUITE 2
PAOLI PA
19301-1776
US

V. Phone/Fax

Practice location:
  • Phone: 610-722-9790
  • Fax: 610-722-0716
Mailing address:
  • Phone: 610-722-9790
  • Fax: 610-722-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS028584L
License Number StatePA

VIII. Authorized Official

Name: DR. STUART M GUTSCHE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 610-722-9790