Healthcare Provider Details

I. General information

NPI: 1477801736
Provider Name (Legal Business Name): MICHAL KUTEN-SHORRER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LONGWOOD AVE
BOSTON MA
02115-5819
US

IV. Provider business mailing address

11 PEABODY TER APT.510
CAMBRIDGE MA
02138-6313
US

V. Phone/Fax

Practice location:
  • Phone: 617-432-1434
  • Fax:
Mailing address:
  • Phone: 857-756-0056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDL11697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: