Healthcare Provider Details

I. General information

NPI: 1225176076
Provider Name (Legal Business Name): MICHAEL J KUTTEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S MERAMEC AVE SUITE 311
SAINT LOUIS MO
63105-3511
US

IV. Provider business mailing address

225 S MERAMEC AVE SUITE 311
SAINT LOUIS MO
63105-3511
US

V. Phone/Fax

Practice location:
  • Phone: 314-727-2420
  • Fax: 314-727-2431
Mailing address:
  • Phone: 314-727-2420
  • Fax: 314-727-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12584
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: