Healthcare Provider Details

I. General information

NPI: 1205200698
Provider Name (Legal Business Name): MARK KUTCHER DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2015
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405C KOHS CB
CHAPEL HILL NC
27599-0001
US

IV. Provider business mailing address

CAMPUS BOX 7450
CHAPEL HILL NC
27599
US

V. Phone/Fax

Practice location:
  • Phone: 919-537-3140
  • Fax:
Mailing address:
  • Phone: 919-537-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0015
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: