Healthcare Provider Details

I. General information

NPI: 1316160047
Provider Name (Legal Business Name): VERNON KIM KUTSCH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 14TH AVE SE
ALBANY OR
97322
US

IV. Provider business mailing address

2200 14TH AVE SE
ALBANY OR
97322
US

V. Phone/Fax

Practice location:
  • Phone: 541-928-9299
  • Fax: 541-928-0075
Mailing address:
  • Phone: 541-928-9299
  • Fax: 541-928-0075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5532
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: