Provider Demographics
NPI:1558853036
Name:LARA GUTIERREZ, PAULINA ARIADNA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:PAULINA
Middle Name:ARIADNA
Last Name:LARA GUTIERREZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:ARIADNA
Other - Middle Name:PAULINA
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:7610 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5411
Mailing Address - Country:US
Mailing Address - Phone:440-975-9300
Mailing Address - Fax:
Practice Address - Street 1:7610 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5411
Practice Address - Country:US
Practice Address - Phone:440-975-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist