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General NPI Number Information
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NPI Number | 1174714547
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Entity Type | Organization
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Legal Business Name | EL MONTE DENTAL GROUP
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 13734 RAMONA AVE
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City | BALDWIN PARK
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State | CA
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Zip | 91706-2430
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Country | US
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Telephone | 626-960-6616
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Fax |
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Provider Business Mailing Address
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Address Line | 3701 SANTA ANITA AVE
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City | EL MONTE
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State | CA
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Zip | 91731-2430
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Country | US
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Telephone | 626-442-4582
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID KUTNER D.MD KUTNER
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Credential | D.M.D
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Telephone | 626-442-4582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27016
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License Number State | CA
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