Provider Demographics
NPI:1427057066
Name:KAUTSKY, MIKAEL B (DDS, PHD)
Entity type:Individual
Prefix:DR
First Name:MIKAEL
Middle Name:B
Last Name:KAUTSKY
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 DELTA LN SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4672
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 EASTSIDE ST SE
Practice Address - Street 2:#4
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-7304
Practice Address - Country:US
Practice Address - Phone:360-943-6378
Practice Address - Fax:360-705-3159
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 77681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice