Provider Demographics
NPI:1689345258
Name:GUTIERREZ ORTHODONTICS
Entity Type:Organization
Organization Name:GUTIERREZ ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-477-4101
Mailing Address - Street 1:4041 DEMOS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4210
Mailing Address - Country:US
Mailing Address - Phone:650-477-4101
Mailing Address - Fax:
Practice Address - Street 1:4420 SONOMA RANCH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8801
Practice Address - Country:US
Practice Address - Phone:650-477-4101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty