Provider Demographics
NPI:1194143222
Name:GUTIERREZ PULIDO, LUIS D (DDS)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:D
Last Name:GUTIERREZ PULIDO
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 1:4041 DEMOS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4210
Mailing Address - Country:US
Mailing Address - Phone:650-477-4101
Mailing Address - Fax:
Practice Address - Street 1:1310 E PINE ST STE B
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-7003
Practice Address - Country:US
Practice Address - Phone:575-329-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002021641223X0400X
AZ94141223X0400X
NMDD50701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics