Provider Demographics
NPI:1841331311
Name:DRS. GORMLEY AND GUTIERREZ PEDIATRIC DENTISTRY, PC
Entity type:Organization
Organization Name:DRS. GORMLEY AND GUTIERREZ PEDIATRIC DENTISTRY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Z
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-522-8229
Mailing Address - Street 1:2701 MISSOURI AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5091
Mailing Address - Country:US
Mailing Address - Phone:505-522-8229
Mailing Address - Fax:505-522-8123
Practice Address - Street 1:2701 MISSOURI AVE STE C
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5091
Practice Address - Country:US
Practice Address - Phone:505-522-8229
Practice Address - Fax:505-522-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty