Provider Demographics
NPI:1720292592
Name:GUTIERREZ, RAUL JOSE (DMD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:JOSE
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 CALLE ALELI
Mailing Address - Street 2:SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6306
Mailing Address - Country:US
Mailing Address - Phone:787-282-7247
Mailing Address - Fax:
Practice Address - Street 1:CARR. 187 KM. 6
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-256-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice