Provider Demographics
NPI:1346400470
Name:MUTCH, NATHANIEL PAUL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHANIEL
Middle Name:PAUL
Last Name:MUTCH
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 1:381 N SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-2662
Mailing Address - Country:US
Mailing Address - Phone:810-664-4542
Mailing Address - Fax:
Practice Address - Street 1:381 N SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-2662
Practice Address - Country:US
Practice Address - Phone:810-664-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010197851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice