Provider Demographics
NPI:1730556515
Name:GUTIERREZ, GUADALUPE II (DMD)
Entity type:Individual
Prefix:DR
First Name:GUADALUPE
Middle Name:
Last Name:GUTIERREZ
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 S EASTERN AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-8036
Mailing Address - Country:US
Mailing Address - Phone:725-331-3291
Mailing Address - Fax:
Practice Address - Street 1:2615 N FRUITLAND LN
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-7914
Practice Address - Country:US
Practice Address - Phone:208-765-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV78881223G0001X
IDD4664122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice