MEDICARE: DR. KARLA GUTIERREZ-OLIVARES 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	1223G0001X	General Practice Dentistry	6557	NV

General Provider Information

NPI Number	:	1700285632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARLA GUTIERREZ-OLIVARES DDS

Provider Business Mailing Address
First Line	:	701 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1510
Country	:	US
Telephone Number	:	702-759-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-1510
Country	:	US
Telephone Number	:	702-759-0005
Fax Number	:

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

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	04/18/2017

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