Organization
TIMOTHY L GUTIERREZ DMD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY LEE GUTIERREZ SR. DMD (ORAL MAXILLOFACIAL SURGEON)
(505) 881-7373
Entity
Organization
Contact information
Practice address
1513 CARLISLE BLVD NE, ALBUQUERQUE, NM 87110
(505) 881-7373
(505) 881-5096
Mailing address
1513 CARLISLE BLVD NE, ALBUQUERQUE, NM 87110
(505) 881-7373
(505) 881-5096
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1556
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88906
—
NM
Enumeration date
12/19/2006
Last updated
08/22/2020
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