Provider Demographics
NPI:1902906811
Name:GUTMAN, ELLIOTT KENNETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:KENNETH
Last Name:GUTMAN
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 1:801 WEST 180 ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3515
Mailing Address - Country:US
Mailing Address - Phone:212-923-1982
Mailing Address - Fax:
Practice Address - Street 1:801 WEST 180 ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3515
Practice Address - Country:US
Practice Address - Phone:212-923-1982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03034801122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist