Active NPI
Juan Carlos Gutierrez, D.D.S.
- Dentist
- Manor, TX
National Provider Identifier
1689768780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 23582
- Practice address
- 14001 Shadow Glen Blvd
Manor, TX 78653-3376 - Phone
- (512) 278-8700
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | 23582 | TX | Primary |
Addresses
Primary practice location
14001 Shadow Glen Blvd
Manor, TX 78653-3376
Mailing address
14001 Shadow Glen Blvd
Manor, TX 78653-3376
Phone (512) 278-8700
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 |
|---|---|---|---|
| 23582 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Manor Dental Associates | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Manor, TX
- NPI 1942460092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213574400000",
"number": "1689768780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14001 SHADOW GLEN BLVD",
"city": "MANOR",
"state": "TX",
"postal_code": "786533376",
"telephone_number": "512-278-8700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14001 SHADOW GLEN BLVD",
"city": "MANOR",
"state": "TX",
"postal_code": "786533376",
"telephone_number": "512-278-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTIERREZ",
"first_name": "JUAN",
"middle_name": "CARLOS",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2008-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "23582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manor, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.