MEDICARE: CRISTINA IZELLAH GUTIERREZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	41629	TX
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223G0001X	General Practice Dentistry	41629	TX

General Provider Information

NPI Number	:	1053010231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTINA IZELLAH GUTIERREZ DDS

Provider Business Mailing Address
First Line	:	427 SINGING OAKS STE 102
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6508
Country	:	US
Telephone Number	:	210-495-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 SINGING OAKS STE 102
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6508
Country	:	US
Telephone Number	:	210-495-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	07/07/2025

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