Provider Demographics
NPI:1588044200
Name:GUTIERREZ, ALESSANDRA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALESSANDRA
Middle Name:MARIE
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 1:10214 COULOAK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7676
Mailing Address - Country:US
Mailing Address - Phone:704-394-3109
Mailing Address - Fax:
Practice Address - Street 1:10214 COULOAK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7676
Practice Address - Country:US
Practice Address - Phone:704-394-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10014122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist