Provider Demographics
NPI:1669648945
Name:MICHAEL P MCNUTT D.D.S., P.C.
Entity Type:Organization
Organization Name:MICHAEL P MCNUTT D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-624-5996
Mailing Address - Street 1:1881 N PONTIAC TRL
Mailing Address - Street 2:SUITE A
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3101
Mailing Address - Country:US
Mailing Address - Phone:248-624-5996
Mailing Address - Fax:
Practice Address - Street 1:1881 N PONTIAC TRL
Practice Address - Street 2:SUITE A
Practice Address - City:WALLED LAKE
Practice Address - State:MI
Practice Address - Zip Code:48390-3101
Practice Address - Country:US
Practice Address - Phone:248-624-5996
Practice Address - Fax:248-624-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010165321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty