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General NPI Number Information
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NPI Number | 1619250271
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Entity Type | Individual
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Provider Name | AHMAD M KUTKUT D.D.S., MS.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 800 ROSE ST
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City | LEXINGTON
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State | KY
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Zip | 40536-0001
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Country | US
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Telephone | 859-323-5996
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ROSE ST RM D104 UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
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City | LEXINGTON
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State | KY
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Zip | 40536-0297
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Country | US
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Telephone | 859-323-5831
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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 | 9124
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 9124
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License Number State | KY
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