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General NPI Number Information
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NPI Number | 1629491766
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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 | 01/25/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 614 E ALDER ST SUITE 6
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City | WALLA WALLA
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State | WA
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Zip | 99362-2073
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Country | US
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Telephone | 509-522-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 614 E ALDER ST SUITE 6
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City | WALLA WALLA
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State | WA
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Zip | 99362-2073
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Country | US
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Telephone | 509-522-0555
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Fax |
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Authorized Official
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Title or Position | OWNER PEDIATRIC DENTIST
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Name | DR. STACEY RAE KUTSCH
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Credential | D.D.S., M.S.
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Telephone | 509-378-2520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DE00010428
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DE00010428
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License Number State | WA
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