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General NPI Number Information
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NPI Number | 1912116971
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Entity Type | Organization
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Legal Business Name | MARTHA GUTIERREZ DDS INC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 12703 PRAIRIE AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-4612
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Country | US
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Telephone | 310-676-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 12703 PRAIRIE AVE
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City | HAWTHORNE
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State | CA
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Zip | 90250-4612
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Country | US
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Telephone | 310-676-2442
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Fax |
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Authorized Official
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Title or Position | OWNER MANAGING DENTIST
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Name | MARTHA LIGIA GUTIERREZ
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Credential | DDS
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Telephone | 310-676-2442
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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 | D44176
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License Number State | CA
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