Provider Demographics
NPI:1114096245
Name:GUTIERREZ, REUBEN G (DDS)
Entity Type:Individual
Prefix:
First Name:REUBEN
Middle Name:G
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 OSUNA RD NE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2087
Mailing Address - Country:US
Mailing Address - Phone:505-293-3311
Mailing Address - Fax:505-293-9847
Practice Address - Street 1:8400 OSUNA RD NE
Practice Address - Street 2:SUITE 1B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2087
Practice Address - Country:US
Practice Address - Phone:505-293-3311
Practice Address - Fax:505-293-9847
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD 12381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice