Provider Demographics
NPI:1760646244
Name:GUTIERREZ, ERICK ELI (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICK
Middle Name:ELI
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6175 OCASA DR
Mailing Address - Street 2:
Mailing Address - City:MIRA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91752-3060
Mailing Address - Country:US
Mailing Address - Phone:951-323-6163
Mailing Address - Fax:
Practice Address - Street 1:14305 BASELINE AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3631
Practice Address - Country:US
Practice Address - Phone:909-355-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist