MEDICARE: DR. GARY G GUTHRIE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2977	AR

General Provider Information

NPI Number	:	1114937323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY G GUTHRIE DDS

Provider Business Mailing Address
First Line	:	2369 E BRISTOL PL
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-2737
Country	:	US
Telephone Number	:	479-582-2630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD STE 10
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8808
Country	:	US
Telephone Number	:	479-527-0707
Fax Number	:	479-527-0201

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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