Provider Demographics
NPI:1962558981
Name:DR. RICHARD GUTIERREZ DDS,MS, INC.
Entity type:Organization
Organization Name:DR. RICHARD GUTIERREZ DDS,MS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:760-370-0770
Mailing Address - Street 1:2011 ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3686
Mailing Address - Country:US
Mailing Address - Phone:760-370-0770
Mailing Address - Fax:760-370-0774
Practice Address - Street 1:2011 ROSS AVE
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3686
Practice Address - Country:US
Practice Address - Phone:760-370-0770
Practice Address - Fax:760-370-0774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty