Provider Demographics
NPI:1780694208
Name:GUTHRIE, BRYAN RAY (DMD, PC)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:RAY
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-3734
Mailing Address - Country:US
Mailing Address - Phone:503-656-2139
Mailing Address - Fax:
Practice Address - Street 1:802 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-3734
Practice Address - Country:US
Practice Address - Phone:503-656-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist