Healthcare Provider Details

I. General information

NPI: 1043379415
Provider Name (Legal Business Name): CHRISTOPHER PATRICK KUTNEY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 HIGHWAY 35
EATONTOWN NJ
07724
US

IV. Provider business mailing address

19 EMMA LANE
JACKSON NJ
08527
US

V. Phone/Fax

Practice location:
  • Phone: 732-544-9101
  • Fax: 732-544-0929
Mailing address:
  • Phone: 732-833-8115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI19585
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: