Provider Demographics
NPI:1356673669
Name:GUTIERREZ, VIRGILIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:
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 1:1910 WOODBURY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4126
Mailing Address - Country:US
Mailing Address - Phone:210-787-9890
Mailing Address - Fax:
Practice Address - Street 1:30420 FM 2978 RD
Practice Address - Street 2:SUITE 350
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77354-6750
Practice Address - Country:US
Practice Address - Phone:281-419-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist