Healthcare Provider Details

I. General information

NPI: 1730245507
Provider Name (Legal Business Name): MATTHEW E KUTZ D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 COTTAGE GROVE RD
MADISON WI
53716-1349
US

IV. Provider business mailing address

4801 COTTAGE GROVE RD
MADISON WI
53716-1349
US

V. Phone/Fax

Practice location:
  • Phone: 608-222-7343
  • Fax: 608-222-7347
Mailing address:
  • Phone: 608-222-7343
  • Fax: 608-222-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5729015
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: