Healthcare Provider Details

I. General information

NPI: 1285691584
Provider Name (Legal Business Name): MARK STEVEN KUCHTA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WASHINGTON ST 135
PARK RIDGE IL
60068-4200
US

IV. Provider business mailing address

207 W. PROSPECT
STREAMWOOD IL
60107
US

V. Phone/Fax

Practice location:
  • Phone: 847-696-3240
  • Fax: 847-696-0588
Mailing address:
  • Phone: 630-483-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: