Provider Demographics
NPI:1700285632
Name:GUTIERREZ-OLIVARES, KARLA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:
Last Name:GUTIERREZ-OLIVARES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-1510
Mailing Address - Country:US
Mailing Address - Phone:702-759-0005
Mailing Address - Fax:
Practice Address - Street 1:701 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1510
Practice Address - Country:US
Practice Address - Phone:702-759-0005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV65571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice