Provider Demographics
NPI:1528465812
Name:GUTHRIE, MICHAEL ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:GUTHRIE
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 1:230 N 21ST ST
Mailing Address - Street 2:UNIT 510
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1095
Mailing Address - Country:US
Mailing Address - Phone:724-612-6486
Mailing Address - Fax:
Practice Address - Street 1:230 N 21ST ST
Practice Address - Street 2:UNIT 510
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1095
Practice Address - Country:US
Practice Address - Phone:724-612-6486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0402071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice