Provider Demographics
NPI:1982120135
Name:RICCI, ALYSSA GUTIERREZ (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:GUTIERREZ
Last Name:RICCI
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 NW 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5694
Mailing Address - Country:US
Mailing Address - Phone:305-773-8035
Mailing Address - Fax:
Practice Address - Street 1:7950 NW 53RD ST UNIT 126-127
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4653
Practice Address - Country:US
Practice Address - Phone:305-847-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-18
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04420003031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty