Provider Demographics
NPI:1295827020
Name:MCCUTCHEON, ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MCCUTCHEON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22646 E 9 MILE RD
Mailing Address - Street 2:STE. B
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1951
Mailing Address - Country:US
Mailing Address - Phone:586-778-4151
Mailing Address - Fax:586-778-3291
Practice Address - Street 1:22646 E 9 MILE RD
Practice Address - Street 2:STE. B
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1951
Practice Address - Country:US
Practice Address - Phone:586-778-4151
Practice Address - Fax:586-778-3291
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist