MEDICARE: DR. KELLY GUTHRIE D.M.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	1223G0001X	General Practice Dentistry	DN20052	FL
2	1223G0001X	General Practice Dentistry	AL4787	AL

General Provider Information

NPI Number	:	1639579626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY GUTHRIE D.M.D.

Provider Business Mailing Address
First Line	:	16443 SEGOVIA CIR S
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33331-4622
Country	:	US
Telephone Number	:	954-347-2308
Fax Number	:

Provider Business Practice Location Address
First Line	:	16443 SEGOVIA CIR S
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33331-4622
Country	:	US
Telephone Number	:	954-347-2308
Fax Number	:

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

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	12/17/2025

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