Provider Demographics
NPI:1740854215
Name:KUTINSKY, AARON MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:MATTHEW
Last Name:KUTINSKY
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 1:165 N DESPLAINES ST APT 316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1446
Mailing Address - Country:US
Mailing Address - Phone:734-255-4833
Mailing Address - Fax:
Practice Address - Street 1:8301 S HOLLAND RD STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-1303
Practice Address - Country:US
Practice Address - Phone:773-488-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL019.0330501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program