Healthcare Provider Details

I. General information

NPI: 1609042464
Provider Name (Legal Business Name): SANDRA KUTTNER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2943 CLUBHOUSE RD
MERRICK NY
11566-4807
US

IV. Provider business mailing address

2943 CLUBHOUSE RD
MERRICK NY
11566-4807
US

V. Phone/Fax

Practice location:
  • Phone: 516-546-0024
  • Fax:
Mailing address:
  • Phone: 516-546-0024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number043116
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: