Provider Demographics
NPI:1659567659
Name:GUTIERREZ, JORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
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 1:1260 PIN OAK RD
Mailing Address - Street 2:STE 208
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6850
Mailing Address - Country:US
Mailing Address - Phone:281-392-0888
Mailing Address - Fax:281-392-9065
Practice Address - Street 1:800 GESSNER RD
Practice Address - Street 2:STE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4276
Practice Address - Country:US
Practice Address - Phone:713-465-7507
Practice Address - Fax:281-392-9065
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX151611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics