Provider Demographics
NPI:1023703824
Name:GUTIERREZ, GABRIELLE ANDREA (DDS)
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANDREA
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 1:1616 MAX WAY
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3944
Mailing Address - Country:US
Mailing Address - Phone:516-359-2410
Mailing Address - Fax:
Practice Address - Street 1:2020 SOUTH RD STE 16
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-7211
Practice Address - Country:US
Practice Address - Phone:845-462-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist