Healthcare Provider Details

I. General information

NPI: 1689355455
Provider Name (Legal Business Name): RYAN KUTZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11334 SSG SIMS ST.
FORT BLISS TX
79908
US

IV. Provider business mailing address

13961 VICTORY SKY AVE
HORIZON CITY TX
79928-7792
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-3368
  • Fax:
Mailing address:
  • Phone: 480-208-3189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: