MEDICARE: MRS. JI AE CUTTER D.M.D

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	5578	NV
2	1223G0001X	General Practice Dentistry	6647229-9922	UT
3	1223G0001X	General Practice Dentistry	27544	TX
4	1223G0001X	General Practice Dentistry	100168	CA

General Provider Information

NPI Number	:	1215110242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JI AE CUTTER D.M.D

Provider Business Mailing Address
First Line	:	6376 SPRING MOUNTAIN RD #3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-220-8488
Fax Number	:	702-476-6573

Provider Business Practice Location Address
First Line	:	6376 SPRING MOUNTAIN RD #3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-220-8488
Fax Number	:	702-476-6573

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/01/2021

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