Provider Demographics
NPI:1982713145
Name:GUTIERREZ, PETER M (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
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 1:373 SEBASTIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4550
Mailing Address - Country:US
Mailing Address - Phone:772-589-7409
Mailing Address - Fax:772-589-0777
Practice Address - Street 1:373 SEBASTIAN BLVD
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4550
Practice Address - Country:US
Practice Address - Phone:772-589-7409
Practice Address - Fax:772-589-0777
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice