MEDICARE: GUSTAVO MANUEL COUTIN 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
1	122300000X	Dentist	3267	LA

General Provider Information

NPI Number	:	1912033812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO MANUEL COUTIN D.D.S.

Provider Business Mailing Address
First Line	:	1010 COMMON ST
Second Line	:	SUITE #810
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2401
Country	:	US
Telephone Number	:	504-529-2120
Fax Number	:	504-524-5039

Provider Business Practice Location Address
First Line	:	1010 COMMON ST
Second Line	:	SUITE #810
City	:	NEW ORLEANS
State	:	LA
Zip	:	70112-2401
Country	:	US
Telephone Number	:	504-529-2120
Fax Number	:	504-524-5039

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ GUSTAVO MANUEL COUTIN D.D.S.” Practice Location

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