Provider Demographics
NPI:1992950281
Name:DAVID KUTNER A DENTAL CORP
Entity type:Organization
Organization Name:DAVID KUTNER A DENTAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-442-4582
Mailing Address - Street 1:695 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3812
Mailing Address - Country:US
Mailing Address - Phone:909-881-2545
Mailing Address - Fax:
Practice Address - Street 1:695 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-3812
Practice Address - Country:US
Practice Address - Phone:909-881-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174714547Medicaid