Provider Demographics
NPI:1881944825
Name:NORMA GUTIERREZ DDS PC
Entity type:Organization
Organization Name:NORMA GUTIERREZ DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-587-1293
Mailing Address - Street 1:2712 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1769
Mailing Address - Country:US
Mailing Address - Phone:540-720-8630
Mailing Address - Fax:540-720-8632
Practice Address - Street 1:2712 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1769
Practice Address - Country:US
Practice Address - Phone:540-720-8630
Practice Address - Fax:540-720-8632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401412787261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental