Provider Demographics
NPI:1528734159
Name:GUTIERREZ, PAUL MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MARTIN
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 1:366 W LAKE MEAD PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7287
Mailing Address - Country:US
Mailing Address - Phone:915-799-4168
Mailing Address - Fax:
Practice Address - Street 1:366 W LAKE MEAD PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7287
Practice Address - Country:US
Practice Address - Phone:702-464-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV79661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty