MEDICARE: CUTLER DENTAL CARE, PLLC

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

General Provider Information

NPI Number	:	1992269179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUTLER DENTAL CARE, PLLC

Provider Business Mailing Address
First Line	:	SHADOW MOUNTAIN DENTAL GROUP
Second Line	:	6525 N. DECATUR BLVD. STE. 150
City	:	LAS VEGAS
State	:	NV
Zip	:	89131
Country	:	US
Telephone Number	:	702-577-1941
Fax Number	:	702-395-7813

Provider Business Practice Location Address
First Line	:	9690 W TROPICANA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89147-2601
Country	:	US
Telephone Number	:	928-277-6575
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. JEROME C CUTLER
Credential	:	DDS
Telephone Number	:	928-830-0175

Provider Enumeration Date	:	01/22/2019
Last Update Date	:	04/08/2019

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