Provider Demographics
NPI:1437598216
Name:CUTLER, CODY (DDS)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:CUTLER
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 1:23424 S 223RD PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3218
Mailing Address - Country:US
Mailing Address - Phone:317-753-1570
Mailing Address - Fax:
Practice Address - Street 1:23844 S POWER RD
Practice Address - Street 2:STE. B106
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6152
Practice Address - Country:US
Practice Address - Phone:317-753-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011994A1223G0001X
AZ8928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice