Healthcare Provider Details

I. General information

NPI: 1700865276
Provider Name (Legal Business Name): MATTHEW PAUL KRUTSCH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GRAND ST
COLDWATER MI
49036-1621
US

IV. Provider business mailing address

50 GRAND ST
COLDWATER MI
49036-1621
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-8289
  • Fax: 517-278-5742
Mailing address:
  • Phone: 517-278-8289
  • Fax: 517-278-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901014809
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901009004
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: