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Organization
MARTHA GUTIERREZ DDS INC
Active
Organization
MARTHA GUTIERREZ DDS INC
Active
Other names
Magic Smile Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MARTHA LIGIA GUTIERREZ DDS (OWNER MANAGING DENTIST)
(310) 676-2442
Entity
Organization
Contact information
Practice address
12703 PRAIRIE AVE, HAWTHORNE, CA 90250-4612
(310) 676-2442
Mailing address
12703 PRAIRIE AVE, HAWTHORNE, CA 90250-4612
(310) 676-2442
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D44176
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D44176
MEDICAL
CA
Enumeration date
05/22/2007
Last updated
11/14/2007
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