Provider Demographics
NPI:1497700660
Name:GUTIERREZ, GEORGE ALBERT (DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:ALBERT
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 1:3830 MCCULLOUGH AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-5262
Mailing Address - Country:US
Mailing Address - Phone:210-824-5437
Mailing Address - Fax:210-826-9606
Practice Address - Street 1:3830 MCCULLOUGH AVE
Practice Address - Street 2:STE. 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5262
Practice Address - Country:US
Practice Address - Phone:210-824-5437
Practice Address - Fax:210-826-9606
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120849802Medicaid