Provider Demographics
NPI:1982451332
Name:GUTIERREZ, JOSUE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSUE
Middle Name:
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 1:2219 E 11TH ST UNIT 418
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-3652
Mailing Address - Country:US
Mailing Address - Phone:863-234-6538
Mailing Address - Fax:
Practice Address - Street 1:103 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-4614
Practice Address - Country:US
Practice Address - Phone:918-358-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK79011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice