Provider Demographics
NPI:1558481820
Name:MUTZIG, KATHRYN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:
Last Name:MUTZIG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 E JOPPA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1802
Mailing Address - Country:US
Mailing Address - Phone:410-321-9477
Mailing Address - Fax:410-321-9607
Practice Address - Street 1:521 E JOPPA RD STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-1802
Practice Address - Country:US
Practice Address - Phone:410-321-9477
Practice Address - Fax:410-321-9607
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100021223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics