Healthcare Provider Details

I. General information

NPI: 1144215005
Provider Name (Legal Business Name): SALVATORE RUSSELL CUTINO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 MARTIN LUTHER KING JR BLVD
DETROIT MI
48208-2576
US

IV. Provider business mailing address

22449 PADDINGTON CT.
NOVI MI
48374
US

V. Phone/Fax

Practice location:
  • Phone: 313-494-6621
  • Fax:
Mailing address:
  • Phone: 586-480-0834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901015314
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: