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NPI Code Detail

MEDICARE: DR. JODI E GUTTENBERG D.D.S.

MEDICARE:  DR. JODI E GUTTENBERG  D.D.S.
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
11223P0221XPediatric Dentistry039539NY

General Provider Information

NPI Number : 1295880276
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JODI E GUTTENBERG D.D.S.
Provider Business Mailing Address
First Line : 111 N PARK AVE
Second Line :
City : ROCKVILLE CENTRE
State : NY
Zip : 11570-4105
Country : US
Telephone Number : 516-678-7422
Fax Number : 516-678-8067
Provider Business Practice Location Address
First Line : 111 N PARK AVE
Second Line :
City : ROCKVILLE CENTRE
State : NY
Zip : 11570-4105
Country : US
Telephone Number : 516-678-7422
Fax Number : 516-678-8067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 07/08/2007

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Directions to “ DR. JODI E GUTTENBERG D.D.S.” Practice Location

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