Provider Demographics
NPI:1003845389
Name:CUTHRELL, DDS AND MOCHNICK, DMD, PA
Entity Type:Organization
Organization Name:CUTHRELL, DDS AND MOCHNICK, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTHRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-765-3712
Mailing Address - Street 1:1341 WESTGATE CENTER DR STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3043
Mailing Address - Country:US
Mailing Address - Phone:336-765-3712
Mailing Address - Fax:336-760-0667
Practice Address - Street 1:1341 WESTGATE CENTER DR STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3043
Practice Address - Country:US
Practice Address - Phone:336-765-3712
Practice Address - Fax:336-760-0667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8990155Medicaid