Healthcare Provider Details

I. General information

NPI: 1821477530
Provider Name (Legal Business Name): KIMBERLY KUTZLER D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY BAUKNECHT

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 BUSINESS PARK DR
STEVENS POINT WI
54482-8838
US

IV. Provider business mailing address

3216 BUSINESS PARK DR
STEVENS POINT WI
54482-8838
US

V. Phone/Fax

Practice location:
  • Phone: 715-544-1277
  • Fax:
Mailing address:
  • Phone: 715-544-1277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1001103-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: