Provider Demographics
NPI:1578633996
Name:GUTIERREZ, ALMA ENEDELIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALMA
Middle Name:ENEDELIA
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3603 W. 26TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3937
Mailing Address - Country:US
Mailing Address - Phone:773-277-3600
Mailing Address - Fax:773-277-7619
Practice Address - Street 1:3603 W. 26TH STREET
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3937
Practice Address - Country:US
Practice Address - Phone:773-277-3600
Practice Address - Fax:773-277-7619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice