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General NPI Number Information
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NPI Number | 1689802613
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Entity Type | Individual
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Provider Name | CRISTIAN RICARDO CRACIUN BRUTTEN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 01/29/2024
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Provider Practice Location Address
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Address Line | 2380 HEALTH DR SW STE 230
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City | WYOMING
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State | MI
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Zip | 49519-9702
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Country | US
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Telephone | 616-341-7701
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Fax | 844-689-1183
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Provider Business Mailing Address
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Address Line | 8030 LIONEL DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-7996
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Country | US
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Telephone | 860-977-5666
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11120
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2901022787
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License Number State | MI
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