MEDICARE: DR. KIMBERLY KUTZLER D.D.S.

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	122300000X	Dentist	1001103-15	WI

General Provider Information

NPI Number	:	1821477530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY KUTZLER D.D.S.

Provider Business Mailing Address
First Line	:	3216 BUSINESS PARK DR
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54482-8838
Country	:	US
Telephone Number	:	715-544-1277
Fax Number	:

Provider Business Practice Location Address
First Line	:	3216 BUSINESS PARK DR
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54482-8838
Country	:	US
Telephone Number	:	715-544-1277
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	07/21/2022

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