Provider Demographics
NPI:1023240009
Name:GUTIERREZ, ANDREW ARCHIBAL (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:ARCHIBAL
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 HEARD STREET, BUILDING 556
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD BARRRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857
Mailing Address - Country:US
Mailing Address - Phone:808-655-8800
Mailing Address - Fax:
Practice Address - Street 1:344 HEARD STREET, BUILDING 556, SCHOFIELD BARRACKS, HI
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-655-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-10003122300000X, 1223G0001X, 1223S0112X
TN106431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice