Healthcare Provider Details

I. General information

NPI: 1326745985
Provider Name (Legal Business Name): DR. NOOR KUTKUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9519 STATE ROUTE 14
STREETSBORO OH
44241-5227
US

IV. Provider business mailing address

9519 STATE ROUTE 14
STREETSBORO OH
44241-5227
US

V. Phone/Fax

Practice location:
  • Phone: 330-423-6779
  • Fax:
Mailing address:
  • Phone: 330-423-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number30.027051
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: