Healthcare Provider Details

I. General information

NPI: 1447371729
Provider Name (Legal Business Name): MICHAEL CURTIS MCCUTCHEON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 STATE ROUTE 339
VINCENT OH
45784
US

IV. Provider business mailing address

PO BOX 159
BARLOW OH
45712-0159
US

V. Phone/Fax

Practice location:
  • Phone: 740-678-0083
  • Fax: 740-678-7833
Mailing address:
  • Phone: 740-678-0083
  • Fax: 740-678-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-02-0305
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: