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General NPI Number Information
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NPI Number | 1295922540
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Entity Type | Organization
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Legal Business Name | JEROME A GUTTMAN DDS, INC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/01/2007
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Provider Practice Location Address
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Address Line | 3301 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-1536
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Country | US
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Telephone | 323-722-6766
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Fax | 323-722-2022
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Provider Business Mailing Address
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Address Line | 319 VIA DE LA PAZ
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272-4631
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Country | US
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Telephone | 310-230-1024
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Fax | 323-722-2022
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEROME ALAN GUTTMAN
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Credential | D.D.S.
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Telephone | 323-722-6766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 29600
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License Number State | CA
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