Bryan Lopez Gutierrez, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401418961 Issued in VA

Practice address

2845 Virginia Ave
Collinsville, VA 24078-2247

Phone

(276) 647-1494

NPI assigned

Jun 24, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Collinsville Dental Associates, PC

  • General Practice Dentistry
  • Collinsville, VA
  • NPI 1013559327
  NPD (past)
• Danville Dental Associates, PC

  • General Practice Dentistry
  • Danville, VA
  • NPI 1295814770
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1750125852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "349 LAUREL WOODS DR",
            "city": "DANVILLE",
            "state": "VA",
            "postal_code": "245405205",
            "telephone_number": "706-313-9122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 VIRGINIA AVE",
            "city": "COLLINSVILLE",
            "state": "VA",
            "postal_code": "240782247",
            "telephone_number": "276-647-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOPEZ GUTIERREZ",
        "first_name": "BRYAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401418961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Collinsville, VA
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.