Provider Demographics
NPI:1427788397
Name:GUTIERREZ, JOEL CESAR (DDS)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:CESAR
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 1:125 ANTLER TRL
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-4203
Mailing Address - Country:US
Mailing Address - Phone:469-231-8164
Mailing Address - Fax:
Practice Address - Street 1:606 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-6544
Practice Address - Country:US
Practice Address - Phone:972-421-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX384231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice