Provider Demographics
NPI:1346646460
Name:ALEXANDER KUTUZA D.M.D PLLC
Entity Type:Organization
Organization Name:ALEXANDER KUTUZA D.M.D PLLC
Other - Org Name:KUTUZA ENDODONTICS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROKSOLYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABOLOYNA-KUTUZA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-380-2112
Mailing Address - Street 1:491 WILLIAMSON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9252
Mailing Address - Country:US
Mailing Address - Phone:704-380-2112
Mailing Address - Fax:704-696-8047
Practice Address - Street 1:491 WILLIAMSON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9252
Practice Address - Country:US
Practice Address - Phone:704-380-2112
Practice Address - Fax:704-696-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC99451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty