Healthcare Provider Details

I. General information

NPI: 1205406741
Provider Name (Legal Business Name): TRENTON DAVIS KUTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

IV. Provider business mailing address

331 LANDRUM PL
CLARKSVILLE TN
37043-6329
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax:
Mailing address:
  • Phone: 931-553-1395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: