Healthcare Provider Details

I. General information

NPI: 1790869824
Provider Name (Legal Business Name): MARGARITA KUTSIKOVICH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34302 EUCLID AVE AMERICAN DENTAL CENTERS
WILLOUGHBY OH
44094
US

IV. Provider business mailing address

6140 PARKLAND BLVD #100 AMERICAN DENTAL CENTERS
MAYFIELD HTS OH
44124
US

V. Phone/Fax

Practice location:
  • Phone: 440-946-4241
  • Fax: 440-946-2974
Mailing address:
  • Phone: 440-446-1555
  • Fax: 440-446-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30021851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: