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General NPI Number Information
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NPI Number | 1457885394
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Entity Type | Organization
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Legal Business Name | GUTENBERG DENTAL CORPORATION
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 7144 AIRWAY AVE
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City | YUCCA VALLEY
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State | CA
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Zip | 92284-3866
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Country | US
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Telephone | 760-365-4400
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Fax | 760-365-4449
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Provider Business Mailing Address
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Address Line | 1417 STERLING RD
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City | REDLANDS
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State | CA
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Zip | 92373-6675
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Country | US
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Telephone | 909-499-7318
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAUREN GUTENBERG
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Credential | DDS, MSD
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Telephone | 909-499-7318
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 59415
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License Number State | CA
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