| Dr Eduard Gutgarts Dds A Professional Dental Corporation | |
|
1510 N Poinsettia Pl Los Angeles CA 90046 | |
| (323) 851-7140 | |
| (323) 851-6117 |
| Full Name | Dr Eduard Gutgarts Dds A Professional Dental Corporation |
|---|---|
| Speciality | Dentist |
| Location | 1510 N Poinsettia Pl, Los Angeles, California |
| Authorized Official Name and Position | Eduard Gutgarts (PRESIDENT) |
| Authorized Official Contact | 3238517140 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Eduard Gutgarts Dds A Professional Dental Corporation 1510 N Poinsettia Pl Los Angeles CA 90046-3611 Ph: (323) 851-7140 | Dr Eduard Gutgarts Dds A Professional Dental Corporation 1510 N Poinsettia Pl Los Angeles CA 90046 Ph: (323) 851-7140 |
| NPI Number | 1942411830 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 06/29/2018 |
| Medicare PECOS PAC ID | 5890041081 |
|---|---|
| Medicare Enrollment ID | O20180629002415 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942411830 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 28564 (California) | Primary |
| Provider Name | Eduard M. Gutgarts |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1689703407 PECOS PAC ID: 6709132996 Enrollment ID: I20180629002439 |
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