MEDICARE: DR. MIKAEL B KAUTSKY DDS, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DE 7768	WA

General Provider Information

NPI Number	:	1427057066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIKAEL B KAUTSKY DDS, PHD

Provider Business Mailing Address
First Line	:	908 DELTA LN SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-4672
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 EASTSIDE ST SE
Second Line	:	#4
City	:	OLYMPIA
State	:	WA
Zip	:	98501-7304
Country	:	US
Telephone Number	:	360-943-6378
Fax Number	:	360-705-3159

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2005
Last Update Date	:	07/08/2007

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