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General NPI Number Information
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NPI Number | 1902072119
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Entity Type | Organization
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Legal Business Name | BRYAN R. GUTHRIE DMD PC
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 802 MOLALLA AVE
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City | OREGON CITY
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State | OR
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Zip | 97045-3734
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Country | US
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Telephone | 503-656-2139
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Fax |
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Provider Business Mailing Address
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Address Line | 802 MOLALLA AVE
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City | OREGON CITY
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State | OR
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Zip | 97045-3734
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Country | US
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Telephone | 503-656-2139
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | BRYAN RAY GUTHRIE
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Credential | DMD
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Telephone | 503-656-2139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6070
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License Number State | OR
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