Provider Demographics
NPI:1679706212
Name:JUTKOWITZ, ARNOLD S (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:S
Last Name:JUTKOWITZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3552
Mailing Address - Country:US
Mailing Address - Phone:212-535-1218
Mailing Address - Fax:212-396-2174
Practice Address - Street 1:785 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3552
Practice Address - Country:US
Practice Address - Phone:212-535-1218
Practice Address - Fax:212-396-2174
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026466-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50354Medicare UPIN