Provider Demographics
NPI:1730177767
Name:GUTIERREZ, DON P (DMD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:P
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1441 CARLISLE BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5610
Mailing Address - Country:US
Mailing Address - Phone:505-255-9859
Mailing Address - Fax:505-268-4073
Practice Address - Street 1:1441 CARLISLE BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-5610
Practice Address - Country:US
Practice Address - Phone:505-255-9859
Practice Address - Fax:505-268-4073
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM15551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0008488Medicaid