MEDICARE: IGOR KUTIN 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	DGD9990	SC
2	122300000X	Dentist	22DI02950300	NJ
3	122300000X	Dentist	DN26171	FL
4	122300000X	Dentist	D-11984	OR
5	122300000X	Dentist	D-5480	ID

General Provider Information

NPI Number	:	1558932517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR KUTIN DDS

Provider Business Mailing Address
First Line	:	8321 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1640
Country	:	US
Telephone Number	:	208-605-3638
Fax Number	:

Provider Business Practice Location Address
First Line	:	8321 W OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-1640
Country	:	US
Telephone Number	:	208-605-3638
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	01/29/2025

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Directions to “ IGOR KUTIN DDS” Practice Location

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