Provider Demographics
NPI:1689802613
Name:BRUTTEN, CRISTIAN RICARDO CRACIUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRISTIAN
Middle Name:RICARDO CRACIUN
Last Name:BRUTTEN
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 1:8030 LIONEL DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-7996
Mailing Address - Country:US
Mailing Address - Phone:860-977-5666
Mailing Address - Fax:
Practice Address - Street 1:2380 HEALTH DR SW STE 230
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9702
Practice Address - Country:US
Practice Address - Phone:616-341-7701
Practice Address - Fax:844-689-1183
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT111201223G0001X
390200000X
MI29010227871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTAJ6217461Other390200000X: STUDENT IN AN ORGANIZED HEALTH CARE/EDUCATION/TRAINING PROGRAM