MEDICARE: DR. LAUREN LOUISE GUTENBERG D.D.S., M.S.D

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	1223P0221X	Pediatric Dentistry	59415	CA

General Provider Information

NPI Number	:	1336428275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN LOUISE GUTENBERG D.D.S., M.S.D

Provider Business Mailing Address
First Line	:	1417 STERLING RD
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92373-6675
Country	:	US
Telephone Number	:	909-499-7318
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 S FARRELL DR
Second Line	:	STE. C-101
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-7992
Country	:	US
Telephone Number	:	760-320-7621
Fax Number	:

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	03/18/2017

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