Provider Demographics
NPI:1588775019
Name:KUTNER, BRIAN M (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:KUTNER
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:PO BOX 584
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-0584
Mailing Address - Country:US
Mailing Address - Phone:856-825-0077
Mailing Address - Fax:856-825-0295
Practice Address - Street 1:707 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3730
Practice Address - Country:US
Practice Address - Phone:856-825-0077
Practice Address - Fax:856-825-0295
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist