Active NPI
George Albert Gutierrez, DDS
- Pediatric Dentistry
- San Antonio, TX
National Provider Identifier
1497700660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 15622
- Practice address
- 3830 McCullough Ave
Ste. 100
San Antonio, TX 78212-5262 - Phone
- (210) 824-5437
- Fax
- (210) 826-9606
- NPI assigned
- May 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 15622 | TX | Primary |
Addresses
Primary practice location
3830 McCullough Ave
Ste. 100
San Antonio, TX 78212-5262
Mailing address
3830 McCullough Ave
Ste. 100
San Antonio, TX 78212-5262
Phone (210) 824-5437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 120849802 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15622 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1361836800000",
"number": "1497700660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3830 MCCULLOUGH AVE",
"address_2": "STE. 100",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125262",
"telephone_number": "210-824-5437",
"fax_number": "210-826-9606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3830 MCCULLOUGH AVE",
"address_2": "STE. 100",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125262",
"telephone_number": "210-824-5437",
"fax_number": "210-826-9606"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "GEORGE",
"middle_name": "ALBERT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-24",
"last_updated": "2013-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TX",
"license": "15622",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "120849802",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.