MEDICARE: DAVID KUTNER DMD A DENTAL GROUP

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	27016	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184879470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID KUTNER DMD A DENTAL GROUP

Provider Business Mailing Address
First Line	:	3701 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2430
Country	:	US
Telephone Number	:	626-442-4582
Fax Number	:

Provider Business Practice Location Address
First Line	:	3701 SANTA ANITA AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2430
Country	:	US
Telephone Number	:	626-442-4582
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID KUTNER
Credential	:	DMD
Telephone Number	:	626-442-4582

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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