Provider Demographics
NPI:1932293909
Name:GUTIERREZ, CARLOS M (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:M
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 1:3420 ALDINE MAIL RTE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-4636
Mailing Address - Country:US
Mailing Address - Phone:281-442-4044
Mailing Address - Fax:281-442-4034
Practice Address - Street 1:3420 ALDINE MAIL RTE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039-4636
Practice Address - Country:US
Practice Address - Phone:281-442-4044
Practice Address - Fax:281-442-4034
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009822002Medicaid