Provider Demographics
NPI:1033277736
Name:GUTIERREZ, JAIME (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FEDERAL ROAD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804
Mailing Address - Country:US
Mailing Address - Phone:203-775-0480
Mailing Address - Fax:203-740-9296
Practice Address - Street 1:304 FEDERAL RD
Practice Address - Street 2:SUITE 217
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2418
Practice Address - Country:US
Practice Address - Phone:203-775-0480
Practice Address - Fax:203-740-9296
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0082751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice