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General NPI Number Information
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NPI Number | 1558932517
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Entity Type | Individual
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Provider Name | IGOR KUTIN DDS
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Gender | Male
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 8321 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-1640
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Country | US
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Telephone | 208-605-3638
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Fax |
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Provider Business Mailing Address
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Address Line | 8321 W OVERLAND RD
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City | BOISE
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State | ID
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Zip | 83709-1640
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Country | US
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Telephone | 208-605-3638
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DGD9990
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02950300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN26171
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-11984
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License Number State | OR
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D-5480
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License Number State | ID
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