Provider Demographics
NPI:1558469890
Name:GUTIERREZ, RICHARD (DDS MS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-5345
Mailing Address - Country:US
Mailing Address - Phone:951-781-7878
Mailing Address - Fax:951-781-8700
Practice Address - Street 1:1825 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-781-7878
Practice Address - Fax:951-781-8654
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA122300000XOtherDENTIST