Provider Demographics
NPI:1528535515
Name:GUTIERREZ, JENNIE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12052 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3090
Mailing Address - Country:US
Mailing Address - Phone:562-863-4775
Mailing Address - Fax:
Practice Address - Street 1:12052 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3090
Practice Address - Country:US
Practice Address - Phone:562-863-4775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice