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General NPI Number Information
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NPI Number | 1033277736
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Entity Type | Individual
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Provider Name | JAIME GUTIERREZ DDS
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Gender | Male
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 304 FEDERAL RD SUITE 217
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City | BROOKFIELD
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State | CT
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Zip | 06804-2418
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Country | US
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Telephone | 203-775-0480
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Fax | 203-740-9296
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Provider Business Mailing Address
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Address Line | 304 FEDERAL ROAD SUITE 217
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City | BROOKFIELD
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State | CT
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Zip | 06804
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Country | US
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Telephone | 203-775-0480
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Fax | 203-740-9296
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008275
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License Number State | CT
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