Provider Demographics
NPI:1194349779
Name:GUTOWSKI, REBECCA PAULINE (DMD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:PAULINE
Last Name:GUTOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3429
Mailing Address - Country:US
Mailing Address - Phone:718-736-2149
Mailing Address - Fax:
Practice Address - Street 1:160 BROADWAY RM 1004
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4213
Practice Address - Country:US
Practice Address - Phone:212-287-1275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-30
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062132122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist