Healthcare Provider Details

I. General information

NPI: 1356378178
Provider Name (Legal Business Name): JAMES MATTHEW KUTNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MDOS/WORK STATION UNIT 14010, ANDERSE AIR FORCE BASE GUAM
APO AP
96543-4010
US

IV. Provider business mailing address

1268 LATTE STONE PL
YIGO GU
96929-1258
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4972
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: