Healthcare Provider Details

I. General information

NPI: 1922115708
Provider Name (Legal Business Name): CARSON L KUTSCH DDS, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1855 10TH AVE SE
ALBANY OR
97322-3275
US

IV. Provider business mailing address

3805 GOLDFISH FARM RD SE
ALBANY OR
97322-5271
US

V. Phone/Fax

Practice location:
  • Phone: 541-926-1813
  • Fax: 541-926-9920
Mailing address:
  • Phone: 541-990-3312
  • Fax: 541-926-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD8575
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: