Robert Byron Guttry, DDS
Individual provider Active NPI General Practice Dentistry · Longview, TX
NPI 1689787608 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689787608
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 18946 (LA)
- Practice address
- 903 Judson Rd
Longview, TX 75601-5114 - Phone
- (903) 758-0189
- Fax
- (903) 758-7970
- NPI assigned
- Aug 16, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160603000659 | TX | Order and Referring Only - Other (Physician) |
5597055509 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18946 | TX | MD | Professional Counselor |
| 18946 | LA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 18946 | LA | Yes |
Addresses
Primary practice location
903 Judson Rd
Longview, TX 75601-5114
Mailing address
903 Judson Rd
Longview, TX 75601-5114
Phone (903) 758-0189
Other providers in Longview, TX
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- Ryan M Guillory
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- Gabriella Marie Gunter
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All providers in Longview, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.