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General NPI Number Information
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NPI Number | 1871110312
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Entity Type | Individual
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Provider Name | EVAN CAUTERUCCI DMD
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Gender | Male
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Dates
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Enumeration Date | 07/01/2020
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 1700 S LINCOLN AVE
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City | LEBANON
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State | PA
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Zip | 17042-7529
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Country | US
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Telephone | 717-272-6621
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Fax |
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Provider Business Mailing Address
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Address Line | 4055 RIDGE AVE APT 2606
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City | PHILADELPHIA
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State | PA
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Zip | 19129-1581
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Country | US
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Telephone |
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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 | DS042708
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License Number State | PA
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