Provider Demographics
NPI:1487338786
Name:GUTIERREZ, MARIA TERESA (DMD)
Entity type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 SW 150TH PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2741
Mailing Address - Country:US
Mailing Address - Phone:786-372-3726
Mailing Address - Fax:
Practice Address - Street 1:5380 DONALD ROSS RD STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-7282
Practice Address - Country:US
Practice Address - Phone:561-323-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice