Provider Demographics
NPI:1962623751
Name:GUTGARTS, ELIOZAR (DDS)
Entity type:Individual
Prefix:MR
First Name:ELIOZAR
Middle Name:
Last Name:GUTGARTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5344
Mailing Address - Country:US
Mailing Address - Phone:323-654-2840
Mailing Address - Fax:323-656-5096
Practice Address - Street 1:7865 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5344
Practice Address - Country:US
Practice Address - Phone:323-654-2840
Practice Address - Fax:323-656-5096
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice