Healthcare Provider Details

I. General information

NPI: 1588775019
Provider Name (Legal Business Name): BRIAN M. KUTNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 COLUMBIA AVE
MILLVILLE NJ
08332-3730
US

IV. Provider business mailing address

PO BOX 584
MILLVILLE NJ
08332-0584
US

V. Phone/Fax

Practice location:
  • Phone: 856-825-0077
  • Fax: 856-825-0295
Mailing address:
  • Phone: 856-825-0077
  • Fax: 856-825-0295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: