Provider Demographics
NPI:1861690034
Name:KUTUZA, ALEXANDER S (DMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:S
Last Name:KUTUZA
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 1:491 WILLIAMSON RD SUITE 208
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117
Mailing Address - Country:US
Mailing Address - Phone:704-380-2112
Mailing Address - Fax:704-696-8047
Practice Address - Street 1:491 WILLIAMSON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9252
Practice Address - Country:US
Practice Address - Phone:704-380-2112
Practice Address - Fax:704-696-8047
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365801223E0200X
NC99451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics