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General NPI Number Information
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NPI Number | 1265381610
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Entity Type | Organization
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Legal Business Name | STACEY KUTSCH, D.D.S., M.S., PLLC
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Dates
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Enumeration Date | 01/27/2026
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 5078 POPE JOHN PAUL II BLVD STE 206
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City | AVE MARIA
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State | FL
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Zip | 34142-9528
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Country | US
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Telephone | 239-212-1242
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Fax | 239-212-1410
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Provider Business Mailing Address
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Address Line | 5078 POPE JOHN PAUL II BLVD STE 206
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City | AVE MARIA
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State | FL
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Zip | 34142-9528
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Country | US
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Telephone | 239-212-1242
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Fax | 239-212-1410
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACEY RAE KUTSCH
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Credential | DDS, MS
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Telephone | 239-212-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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