Healthcare Provider Details

I. General information

NPI: 1962025643
Provider Name (Legal Business Name): CUTLER FRANDSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 05/28/2020
Certification Date: 05/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 N 100 E
GUNNISON UT
84634-7720
US

IV. Provider business mailing address

PO BOX 386
GUNNISON UT
84634-0386
US

V. Phone/Fax

Practice location:
  • Phone: 435-528-7316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11770498-0702
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: