Provider Demographics
NPI:1881815702
Name:GUTIERREZ, LUIS F (MAGD, DDS)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:MAGD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 S ALLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-8606
Mailing Address - Country:US
Mailing Address - Phone:941-365-5552
Mailing Address - Fax:
Practice Address - Street 1:1120 S ALLENDALE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-8606
Practice Address - Country:US
Practice Address - Phone:941-365-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist