Healthcare Provider Details

I. General information

NPI: 1295746170
Provider Name (Legal Business Name): DR. ALLISON KUTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

221 2ND AVE S STE 102
KENT WA
98032-5873
US

IV. Provider business mailing address

221 2ND AVE S STE 102
KENT WA
98032-5873
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-1940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE9693
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: