Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DL11540 | MA |
Y | 1223D0004X | Dentist Anesthesiologist | 9322 | KY |
NPI | 1396009338 |
---|---|
Provider Name | Dr. David Burrell Guthrie III |
First Address | Louisville, KY 40205-2809 |
Second Address | Lexington, KY 40510-1034 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2012 |
Last Update Date | 15/06/2021 |