Provider Demographics
NPI:1396592002
Name:GUTIERREZ, DANIEL ALEJANDRO (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALEJANDRO
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 1:620 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-5035
Mailing Address - Country:US
Mailing Address - Phone:805-922-7725
Mailing Address - Fax:805-922-7726
Practice Address - Street 1:620 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-5035
Practice Address - Country:US
Practice Address - Phone:805-922-7725
Practice Address - Fax:805-922-7726
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1097451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice