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General NPI Number Information
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NPI Number | 1770700205
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Entity Type | Individual
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Provider Name | KEITH D KUTZ DDS
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 TRUMAN ST
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City | KIMBERLY
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State | WI
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Zip | 54136-2211
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Country | US
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Telephone | 920-733-3339
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Fax |
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Provider Business Mailing Address
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Address Line | W5936 BLAZING STAR DR
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City | APPLETON
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State | WI
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Zip | 54915-7418
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Country | US
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Telephone | 920-731-3363
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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 | 2783-015
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License Number State | WI
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