Provider Demographics
NPI:1821477530
Name:KUTZLER, KIMBERLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:KUTZLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BAUKNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3216 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8838
Mailing Address - Country:US
Mailing Address - Phone:715-544-1277
Mailing Address - Fax:
Practice Address - Street 1:3216 BUSINESS PARK DR
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8838
Practice Address - Country:US
Practice Address - Phone:715-544-1277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001103-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist