Provider Demographics
NPI:1053617969
Name:PETER M. GUTIERREZ, D.D.S. AND KATHERINE SCURES-GUTIERREZ, D.D.S., P.A
Entity type:Organization
Organization Name:PETER M. GUTIERREZ, D.D.S. AND KATHERINE SCURES-GUTIERREZ, D.D.S., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCURES-GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-589-7409
Mailing Address - Street 1:373 SEBASTIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4550
Mailing Address - Country:US
Mailing Address - Phone:772-589-7409
Mailing Address - Fax:772-589-0777
Practice Address - Street 1:373 SEBASTIAN BLVD
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4550
Practice Address - Country:US
Practice Address - Phone:772-589-7409
Practice Address - Fax:772-589-0777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982713145OtherINDIVIDUAL NPI
1578672721OtherINDIVIDUAL NPI