Provider Demographics
NPI:1083671515
Name:CUTILLI, BRUCE J (DMD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:CUTILLI
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 1:809 N BETHLEHEM PIKE
Mailing Address - Street 2:PO BOX 857
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0857
Mailing Address - Country:US
Mailing Address - Phone:215-591-9354
Mailing Address - Fax:215-591-9356
Practice Address - Street 1:809 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-0857
Practice Address - Country:US
Practice Address - Phone:215-591-9354
Practice Address - Fax:215-591-9356
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025175L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery