Provider Demographics
NPI:1861764052
Name:GUTHRIE, MARY M (RDH,EF)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:GUTHRIE
Suffix:
Gender:F
Credentials:RDH,EF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39443 WALL ST
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-5392
Mailing Address - Country:US
Mailing Address - Phone:541-604-6076
Mailing Address - Fax:
Practice Address - Street 1:20360 SE HIGHWAY 212
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-7722
Practice Address - Country:US
Practice Address - Phone:503-658-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4946124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist