Provider Demographics
NPI:1972657443
Name:GUTENTAG, HERBERT NORMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:NORMAN
Last Name:GUTENTAG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1732
Mailing Address - Country:US
Mailing Address - Phone:732-741-1567
Mailing Address - Fax:732-741-3113
Practice Address - Street 1:200 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1732
Practice Address - Country:US
Practice Address - Phone:732-741-1567
Practice Address - Fax:732-741-3113
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ082691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics