Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 30 02 1434 | OH |
NPI | 1164489787 |
---|---|
Provider Name | Dr. Rostislav R. Gutarts |
First Address | Solon, OH 44139-6904 |
Second Address | Parma, OH 44129-5649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 18/11/2014 |