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NPI Code Detail

MEDICARE: MICHELLE DAYANNE GUTIERREZ RESTO

MEDICARE: MICHELLE DAYANNE GUTIERREZ RESTO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry062863NY

General Provider Information

NPI Number : 1144801945
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DAYANNE GUTIERREZ RESTO
Provider Business Mailing Address
First Line : 1573 3RD AVE APT 4B
Second Line :
City : NEW YORK
State : NY
Zip : 10128-2717
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 169 WYCKOFF AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11237-4303
Country : US
Telephone Number : 646-393-5454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2021
Last Update Date : 04/16/2025

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Directions to “ MICHELLE DAYANNE GUTIERREZ RESTO ” Practice Location

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