Provider Demographics
NPI:1376876110
Name:KENT CUTFORTH DDS
Entity Type:Organization
Organization Name:KENT CUTFORTH DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:CUTFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-523-3388
Mailing Address - Street 1:1370 E. 17TH STREET
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404
Mailing Address - Country:US
Mailing Address - Phone:208-523-3388
Mailing Address - Fax:208-535-0995
Practice Address - Street 1:1370 E. 17TH STREET
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404
Practice Address - Country:US
Practice Address - Phone:208-523-3388
Practice Address - Fax:208-535-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-11
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID001169300Medicaid
ID808413300Medicaid