Provider Demographics
NPI:1588862015
Name:GUTIERREZ, TIMOTHY AARON (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:AARON
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 1:21703 KINGSLAND BLVD
Mailing Address - Street 2:#104
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2520
Mailing Address - Country:US
Mailing Address - Phone:713-540-8877
Mailing Address - Fax:
Practice Address - Street 1:21703 KINGSLAND BLVD
Practice Address - Street 2:#104
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2520
Practice Address - Country:US
Practice Address - Phone:713-540-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice