Provider Demographics
NPI:1477040863
Name:GUTIERREZ PEDIATRIC DENTISTRY, PC
Entity Type:Organization
Organization Name:GUTIERREZ PEDIATRIC DENTISTRY, PC
Other - Org Name:YOUR CHILD'S DENTIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:GUTIERREZ
Authorized Official - Last Name:JEFFORDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:210-771-5389
Mailing Address - Street 1:7322 W MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-2924
Mailing Address - Country:US
Mailing Address - Phone:210-673-3792
Mailing Address - Fax:
Practice Address - Street 1:7322 W MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-2924
Practice Address - Country:US
Practice Address - Phone:210-673-3792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty