Provider Demographics
NPI:1316160047
Name:KUTSCH, VERNON KIM (DMD)
Entity type:Individual
Prefix:MR
First Name:VERNON
Middle Name:KIM
Last Name:KUTSCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 14TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322
Mailing Address - Country:US
Mailing Address - Phone:541-928-9299
Mailing Address - Fax:541-928-0075
Practice Address - Street 1:2200 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97322
Practice Address - Country:US
Practice Address - Phone:541-928-9299
Practice Address - Fax:541-928-0075
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD55321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice