Provider Demographics
NPI:1790869824
Name:KUTSIKOVICH, MARGARITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:KUTSIKOVICH
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 1:6140 PARKLAND BLVD
Mailing Address - Street 2:#100 AMERICAN DENTAL CENTERS
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-446-1555
Mailing Address - Fax:440-446-1990
Practice Address - Street 1:34302 EUCLID AVE
Practice Address - Street 2:AMERICAN DENTAL CENTERS
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094
Practice Address - Country:US
Practice Address - Phone:440-946-4241
Practice Address - Fax:440-946-2974
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300218511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice