Healthcare Provider Details

I. General information

NPI: 1508225939
Provider Name (Legal Business Name): MICHAEL KUTSYK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10014 US HIGHWAY 301 N
PARRISH FL
34219-8493
US

IV. Provider business mailing address

10014 US HIGHWAY 301 N
PARRISH FL
34219-8493
US

V. Phone/Fax

Practice location:
  • Phone: 941-842-2240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number059297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: