MEDICARE: CASEY D CUTLER 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	1223G0001X	General Practice Dentistry	10158	AZ

General Provider Information

NPI Number	:	1821545500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY D CUTLER DDS

Provider Business Mailing Address
First Line	:	3048 E BASELINE RD STE 128
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-7288
Country	:	US
Telephone Number	:	480-820-6080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3048 E BASELINE RD STE 128
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85204-7288
Country	:	US
Telephone Number	:	480-820-6080
Fax Number	:

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

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	09/10/2019

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