Provider Demographics
NPI:1699228775
Name:GUTIERREZ, ROSE MARIE (RDH, BSDH)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:MARIE
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 STANLEY ROAD
Mailing Address - Street 2:FT. SAM HOUSTON, US ARMY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-295-4156
Mailing Address - Fax:210-295-5832
Practice Address - Street 1:1960 STANLEY RD
Practice Address - Street 2:FT. SAM HOUSTON, US ARMY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7650
Practice Address - Country:US
Practice Address - Phone:210-295-4156
Practice Address - Fax:210-295-5832
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6784124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6784OtherTEXAS STATE BOARD OF DENTAL EXAMINERS