Connor K Guttmann, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

13421569-9921 Issued in UT

Practice address

Oral and Maxillofacial Surgery
3551 Roger Brooke Dr.
Fort Sam Houston, TX 78234

Phone

(210) 916-2549

NPI assigned

Mar 7, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715904000000",
    "number": "1518667674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ORAL AND MAXILLOFACIAL SURGERY",
            "address_2": "3551 ROGER BROOKE DR.",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "212-916-2549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ORAL AND MAXILLOFACIAL SURGERY",
            "address_2": "3551 ROGER BROOKE DR.",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "78234",
            "telephone_number": "210-916-2549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTTMANN",
        "first_name": "CONNOR",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-07",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "13421569-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Gustafson, M.D.
• Lisa Leanne Gustafson, LMSW
• Angelica Gutierrez, MSN, RN
• Edwin Xavier Gutierrez, PA-C
• Vanessa Marie Gutierrez, PHARMD
• Hanya Habib, MD
• William G Hagblom
• Daniel Conrad Hagen, D.O.
• Taryn Renee Hagerman, LCSW, BCD
• Paul S Hahn, M.D.

• Dentist in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.