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General NPI Number Information
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NPI Number | 1871750745
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Entity Type | Organization
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Legal Business Name | GREGORY J. KUCHTJAK, D.M.D., P.A.
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 933 N CAROLINA AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3414
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Country | US
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Telephone | 704-883-8516
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Fax | 704-883-8560
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Provider Business Mailing Address
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Address Line | 933 N CAROLINA AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-3414
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Country | US
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Telephone | 704-883-8516
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Fax | 704-883-8560
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Authorized Official
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Title or Position | PRESIDENT/PEDIATRIC DENTIST
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Name | DR. GREGORY J. KUCHTJAK
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Credential | D.M.D.
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Telephone | 704-883-8516
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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 | 7068
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License Number State | NC
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