Provider Demographics
NPI:1093292799
Name:GUTIERREZ, SELINA FUENTES (DDS)
Entity Type:Individual
Prefix:DR
First Name:SELINA
Middle Name:FUENTES
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SELINA
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:79 CAREFREE CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4392
Mailing Address - Country:US
Mailing Address - Phone:956-693-0794
Mailing Address - Fax:
Practice Address - Street 1:16619 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-2330
Practice Address - Country:US
Practice Address - Phone:210-408-7244
Practice Address - Fax:210-408-7950
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice