MEDICARE: DR. SERGIO KUTTLER BS, DDS

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	1223E0200X	Endodontics	DTP279	FL

General Provider Information

NPI Number	:	1740297852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SERGIO KUTTLER BS, DDS

Provider Business Mailing Address
First Line	:	11202 NW 9TH STREET
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-1523
Country	:	US
Telephone Number	:	954-900-4305
Fax Number	:

Provider Business Practice Location Address
First Line	:	11202 NW 9TH ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33325-1523
Country	:	US
Telephone Number	:	954-900-4305
Fax Number	:

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	07/21/2022

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