Provider Demographics
NPI:1134489198
Name:KUTANOVSKI, CHRIS DAVID (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:DAVID
Last Name:KUTANOVSKI
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8782 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7202
Mailing Address - Country:US
Mailing Address - Phone:219-613-3846
Mailing Address - Fax:
Practice Address - Street 1:8782 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7202
Practice Address - Country:US
Practice Address - Phone:317-882-2882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011791A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty