Provider Demographics
NPI:1265533194
Name:GUTT, MARK I (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:I
Last Name:GUTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE #304
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:305-538-2112
Mailing Address - Fax:305-672-6056
Practice Address - Street 1:975 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE #304
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140
Practice Address - Country:US
Practice Address - Phone:305-538-2112
Practice Address - Fax:305-672-6056
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00119901223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics