MEDICARE: JI AE CUTTER DMD PROFESSIONAL CORP

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1528726031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JI AE CUTTER DMD PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	6376 SPRING MOUNTAIN RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8818
Country	:	US
Telephone Number	:	702-220-8488
Fax Number	:

Provider Business Practice Location Address
First Line	:	6376 SPRING MOUNTAIN RD STE 3
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-8818
Country	:	US
Telephone Number	:	702-220-8488
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	JI AE CUTTER
Credential	:	DMD
Telephone Number	:	702-220-8488

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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