Provider Demographics
NPI:1497316590
Name:GUTIERREZ, TRINY (DMD, MS)
Entity Type:Individual
Prefix:
First Name:TRINY
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4743
Mailing Address - Country:US
Mailing Address - Phone:203-202-7610
Mailing Address - Fax:
Practice Address - Street 1:777 BOSTON POST RD
Practice Address - Street 2:#300
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820
Practice Address - Country:US
Practice Address - Phone:203-202-7610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18593041223X0400X
NC114301223G0001X, 1223X0400X
NY0632101223X0400X
CT133781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice