Provider Demographics
NPI:1215636170
Name:MCNUTT, GUERIN BEARDEN
Entity type:Individual
Prefix:MRS
First Name:GUERIN
Middle Name:BEARDEN
Last Name:MCNUTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SWANNER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-9297
Mailing Address - Country:US
Mailing Address - Phone:865-591-5772
Mailing Address - Fax:
Practice Address - Street 1:3720 CUNNINGHAM RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-5303
Practice Address - Country:US
Practice Address - Phone:865-922-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8716124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist