Individual
MRS. NELLY GUTIERREZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTAL ASSISTANTEFDA
Contact information
Practice address
10590 ENDURING FREEDOM DR, FORT DRUM, NY 13602-5005
(315) 772-6234
Mailing address
10590 ENDURING FREEDOM DR, FORT DRUM, NY 13602-5005
(315) 772-6234
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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