Provider Demographics
NPI:1104020536
Name:KUTIS, SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:KUTIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10354 W CHATFIELD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-6408
Mailing Address - Country:US
Mailing Address - Phone:720-771-4476
Mailing Address - Fax:
Practice Address - Street 1:10354 W CHATFIELD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-6408
Practice Address - Country:US
Practice Address - Phone:720-771-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2016-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO91901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice