Provider Demographics
NPI:1568980274
Name:GUTIERREZ, MELISSA JEAN (RDH)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5302 HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-1523
Mailing Address - Country:US
Mailing Address - Phone:715-204-1180
Mailing Address - Fax:
Practice Address - Street 1:941 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481
Practice Address - Country:US
Practice Address - Phone:715-204-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist