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General NPI Number Information
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NPI Number | 1346646460
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Entity Type | Organization
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Legal Business Name | ALEXANDER KUTUZA D.M.D PLLC
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Dates
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Enumeration Date | 11/17/2014
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 491 WILLIAMSON RD SUITE 208
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City | MOORESVILLE
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State | NC
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Zip | 28117-9252
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Country | US
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Telephone | 704-380-2112
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Fax | 704-696-8047
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Provider Business Mailing Address
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Address Line | 491 WILLIAMSON RD SUITE 208
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City | MOORESVILLE
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State | NC
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Zip | 28117-9252
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Country | US
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Telephone | 704-380-2112
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Fax | 704-696-8047
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Authorized Official
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Title or Position | MANAGER
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Name | ROKSOLYANA ZABOLOYNA-KUTUZA
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Credential | DMD
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Telephone | 704-380-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 9945
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License Number State | NC
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