Provider Demographics
NPI:1396088654
Name:GUTIERREZ FAMILY DENTAL PLLC
Entity type:Organization
Organization Name:GUTIERREZ FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPAYRA-GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-835-7725
Mailing Address - Street 1:8740 N LAMAR BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5440
Mailing Address - Country:US
Mailing Address - Phone:512-835-7725
Mailing Address - Fax:512-835-2840
Practice Address - Street 1:8740 N LAMAR BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5440
Practice Address - Country:US
Practice Address - Phone:512-835-7725
Practice Address - Fax:512-835-2840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty