Provider Demographics
NPI:1922653252
Name:GUTIERREZ, ELIAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
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:PO BOX 500169
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-0169
Mailing Address - Country:US
Mailing Address - Phone:670-234-6323
Mailing Address - Fax:
Practice Address - Street 1:1 QUARTERMASTER ROAD, CHALAN LAULAU
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:NORTHERN MARIANA ISLANDS
Practice Address - Zip Code:96950
Practice Address - Country:UM
Practice Address - Phone:670-234-6323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS103843122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist