Provider Demographics
NPI:1063746642
Name:GUTIERREZ, ALAN ELIAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ELIAS
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 1:13203 HADLEY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4519
Mailing Address - Country:US
Mailing Address - Phone:562-413-6993
Mailing Address - Fax:562-907-6002
Practice Address - Street 1:13203 HADLEY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4519
Practice Address - Country:US
Practice Address - Phone:562-413-6993
Practice Address - Fax:562-907-6002
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA482791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice